April 6, 2021

expert reaction to observational study looking at neurological and psychiatric outcomes 6 months after COVID-19

An observational study published in The Lancet Psychiatry looks at 6-month neurological and psychiatric outcomes in survivors of COVID-19.

This Roundup accompanied an SMC Briefing.

Dr Richard Francis, Head of Research at the Stroke Association said:

“It’s concerning that this study, primarily based on United States data, finds people with Covid-19 may be at a higher risk of stroke. There have been multiple reports linking Covid-19 and stroke, but few large studies like this to understand Covid-19 as a stroke risk factor.

“Risk of having a stroke with Covid-19 is low, but higher than other infections. The study finds that compared to people that had an influenza infection, infection with Covid-19 has a 62% higher risk of stroke caused by blood clots (ischaemic), and 71% higher risk of stroke caused by a bleed in the brain (intracranial haemorrhage). The risk of stroke appears highest in people hospitalised with Covid-19 and those that have inflammation in the brain.

“However, more research is needed to understand if people with mild cases of Covid-19 are at risk, as well as why the risk of stroke may increase and for how long after Covid-19 infection. Our charity is funding some of this work using health data from people in the UK. This is important to understand the impact of Covid-19 on stroke in the UK, as well as how treatment and care for stroke survivors may need to change in response to the virus.”

Prof Sir Simon Wessely, Regius Chair of Psychiatry, King’s College London, said:

“This is a very important paper. It confirms beyond any reasonable doubt that COVID-19 affects both brain and mind in equal measure.  Some were already known – for example increased rates of stroke and also anxiety disorders.  Others less so  – dementia and psychosis for example.  What is very new is the comparisons with all respiratory viruses or influenza, which suggests that these increases are specifically related to COVID-19, and not a general impact of viral infection. In general the worse the illness, the greater were the neurological or psychiatric outcomes, which is perhaps not surprising.    The worst outcomes were in those with encephalopathy – inflammation of the brain – again, not surprising.  The association with dementia was however small, and might reflect diagnostic issues, whilst so far there doesn’t seem early evidence of a link with Parkinsonism, which was a major factor after the great Spanish Flu pandemic, although the authors caution that it is too early to rule this out.”

Prof Dame Til Wykes, Vice Dean Psychology and Systems Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, said:

“This is a carefully controlled and considered study looking back on 2020 Covid-19 cases mostly in the USA over six months. But it also has some limitations not least the dependence on US data, looking back not forwards, and the potential for treatments developed in 2020 to change the types and incidence of problems.”

“The study confirms our suspicions that a Covid-19 diagnosis is not just related to respiratory symptoms, it is also related to psychiatric and neurological problems.”

“Looking over 6 months after diagnosis has demonstrated that the “after-effects” can appear much later than expected – something that is no surprise to those suffering from Long Covid. Although as expected the outcomes are more serious in those admitted to hospital, the study does point out that serious effects are also evident in those who had not been admitted to hospital.”

“There is little good news from these data except that the anxiety and depression rates were decreasing compared to data collected 3 months after diagnosis, but this is balanced by the increase in more serious psychotic illnesses.”

“The next step is to understand how new treatments – discovered in the UK National Institute for Health Research funded Recovery Trial – have affected the appearance of these medical and psychiatric outcomes. The hope is that these new treatments will prevent poor medical outcomes. The psychiatric difficulties are harder to prevent as it is more likely that psychological and social influences following a Covid diagnosis, and its physical effects, influence whether these mood problems appear and persist.”

Prof Paul Crawford, Director, Centre for Social Futures, Institute of Mental Health, University of Nottingham, said:

“Taquet et al’s study identifies substantial neurological and psychiatric morbidity in the 6 months after COVID-19 infection. However, we will need to determine whether this results from infection or the effects of prolonged confinement and isolation, popularly referred to as ‘cabin fever’, endured during the pandemic. We know from penal, remote living and aerospace studies, not least in relation to long-duration flight, that such conditionality can affect mental state in terms of experiencing anxiety, depression, lassitude, irritability and other cognitive disturbances.”

Dr Musa Sami, Clinical Associate Professor in Psychiatry, University of Nottingham, said:

“This is a robust piece of work in a large cohort demonstrating the association between COVID-19 and psychiatric and neurological complications. This is a very important topic as there has been considerable consternation regarding COVID-19 as a ‘brain disease’. We need accurate data and estimates of the size of this association before we can draw this conclusion.  There are several strengths to this work: a very large sample size, adjusting for a variety of confounders, and appropriate control samples. All together around 1 in 3 patients who develop COVID-19 will have a neurological or psychiatric disorder at six months, and 1 in 9 patients of those who develop COVID-19 will receive a new diagnosis of neurological or psychiatric disorder. We would expect individuals with influenza and other respiratory illnesses to also present with some of these illnesses, and they do. What this paper shows is that COVID-19 makes the presentation of these illnesses more likely in the order of around 44% for influenza and 16% for other respiratory illnesses. What we do not fully understand at the moment is the mechanism by which COVID-19 has this effect: psychological stress, longer stays in hospital and characteristics of the illness itself may play a part. 

“This data provides very important information for services and policy makers to estimate the burden of neurological and psychiatric disease from COVID-19. What is important for the public to remember is that most patients who develop COVID-19 will not develop these complications. The severity of COVID-19 appears to be associated with increased likelihood of developing these complications in those admitted to ITU or those diagnosed with encephalopathy and delirium. Those experiencing psychological or neurological symptoms should seek medical attention and remember that effective treatments are available for many of these conditions.”

Lea Milligan, CEO MQ Mental Health research, said:

“It is clear from this study that the impact COVID-19 is having on individuals mental health can be severe. The PHOSP-COVID study, which was supported by MQ, also found that 25% of people were experiencing significant symptoms of anxiety and depression five months after leaving hospital. This is contributing to the already rising levels of mental illness and requires further, urgent research.”

‘6 -month neurological and psychiatric outcomes in 236379 survivors of COVID-19: a retrospective cohort study using electronic health records’ by Maxime Tarquet et al. was published in The Lancet Psychiatry at 23:30 UK time on Tuesday 6 April.

All our previous output on this subject can be seen at this weblink:

www.sciencemediacentre.org/tag/covid-19

Declared interests

Prof Paul Crawford: “No declarations.”

None others received.