Post/Long COVID neurotoxicity

[Jules A]

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What have you seen with regard to new onset psychiatric presentations in adults with no mental health history? I'm not referring to the acute encephalopathy we are seeing in CL which isn't surprising but in outpatient in those who were not hospitalized. I just picked up two new patients who were high functioning with no history of mental health diagnosis, no history of medication with acute onset profound anxiety and insomnia to the point where they are struggling to function which has extended months after recovering from a mild to moderate course.

 

[WisNeuro]

At least on our side of things, we see more cerebrovascular issues (stroke manifestations, small vessel) and some myelination disorder stuff (e.g., ADEM). Still pretty early in the research to see the extent and chronicity of these things. As for the psychiatric manifestations, the hard part is teasing out what may be due to complications with the infections vs. Axis IV type issues.

 

[Stagg737]

What have you seen with regard to new onset psychiatric presentations in adults with no mental health history? I'm not referring to the acute encephalopathy we are seeing in CL which isn't surprising but in outpatient in those who were not hospitalized. I just picked up two new patients who were high functioning with no history of mental health diagnosis, no history of medication with acute onset profound anxiety and insomnia to the point where they are struggling to function which has extended months after recovering from a mild to moderate course.

Interesting, I've had a couple patients who also had a similar situation, specifically with anxiety and insomnia. I've mostly chalked the anxiety up to being part of an "other stressor related disorder" and a psychological residual from having COVID. Insomnia in one or two of my patients seemed to be more rooted in possible physiological changes as it was resistant to medications, but that's total speculation.

 

[birchswing]

In terms of COVID, this is probably now considered old as things change so quickly, but I bookmarked this a while back to reference back to:

How COVID-19 Affects the Brain

This article discusses possible pathogenic mechanisms of brain dysfunction in patients with COVID-19.

jamanetwork.com

Also this regarding the vaccines themselves (I am vaccinated and glad to be so), here is some interesting info (especially interesting info in the comments themselves regarding possible effects long term, especially with multiple administrations—having said that I am not presenting this to be alarmist; rather, I am looking forward to getting my booster when it's my time):

AAAS

blogs.sciencemag.org

 

[PsyDr]

The only neuro lecture I've seen was limited to autopsy findings, which were complicated by comorbidities.

Likely some combo of emotional reaction to almost dying, respiratory changes, and that "CO2 hypersensitivty" thing.

 

[NickNaylor]

I've had 2 cases of patients with no prior history of significant psychiatric symptoms seemingly develop psychosis within a few months after COVID infection. One patient was an otherwise generally healthy, 50ish patient with no prior psychiatric history who became increasingly paranoid and disorganized after recovering from COVID. The spouse described the onset of symptoms as "like a light switch." The other patient was older (70s) who may have also been delirious though followed a somewhat similar course per the patient's spouse. That patient ultimately had a seizure while on our unit and was transferred to neurology for further work-up, and I never followed up to see what the work-up revealed.

 

[Mass Effect]

There are definitely neuropsychiatric syndromes following Covid infection. I've seen several pts like this but the majority are presenting with cognitive deficits, usually executive function limitations in previously healthy, high-functioning individuals, including healthcare workers.

 

[Jules A]

There are definitely neuropsychiatric syndromes following Covid infection. I've seen several pts like this but the majority are presenting with cognitive deficits, usually executive function limitations in previously healthy, high-functioning individuals, including healthcare workers.

Scary.

I have also recently seen a few incidents of fully vaccinated elderly patients present to ED with delirium-acute confusion and or behavioral issues test positive for COVID without any of the anticipated respiratory type symptoms.