Hostname: page-component-cd9895bd7-hc48f Total loading time: 0 Render date: 2024-12-22T23:52:51.642Z Has data issue: false hasContentIssue false
  • English
  • Français

Neuropsychiatric symptoms in post-COVID-19 long haulers

Published online by Cambridge University Press:  11 May 2022

Hussam Y. Alghamdi ,
Abdulaziz M. Alrashed ,
Amjad M. Jawhari  and
Ahmed S. Abdel-Moneim Open the ORCID record for Ahmed S. Abdel-Moneim [Opens in a new window]
Hussam Y. Alghamdi
Affiliation:
College of Medicine, Taif University, Al-Taif21944, Saudi Arabia
Abdulaziz M. Alrashed
Affiliation:
College of Medicine, Taif University, Al-Taif21944, Saudi Arabia
Amjad M. Jawhari
Affiliation:
College of Medicine, Taif University, Al-Taif21944, Saudi Arabia
Ahmed S. Abdel-Moneim*
Affiliation:
Microbiology Department, College of Medicine, Taif University, Al-Taif, Saudi Arabia
*
Author for correspondence: Ahmed S. Abdel-Moneim, Emails: [email protected]; [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Long haulers have been recently reported after contracting coronavirus disease (COVID-19). In the present study, we aimed to screen for the neuropsychiatric signs detected <1 to >6 months after infection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and to determine whether vaccination has an effect on them.

Methods:

An online survey was conducted among participants who had been diagnosed with laboratory-confirmed SARS-CoV-2 infection. The clinical signs and durations of neuropsychiatric complaints and their correlations to sex, age, severity of COVID-19 signs, and vaccination status were screened.

Results:

A total of 2218 individuals, including 1358 females and 860 males, with an age range of 12–70 years, submitted their responses. The respondents experienced cognitive dysfunction, mood alteration, depression, tinnitus, sleep disorders, and loss of taste and smell, with prevalence rates ranging from 18.9% (tinnitus) to 63.9% (loss of taste and smell). Of the respondents, 2.2–7.7% confirmed the persistence of symptoms for >6 months. Tinnitus was the least common complaint, and only 2.2% of the study participants had tinnitus for >6 months. Meanwhile, mood alteration persisted for >6 months in 7.6% of the study participants. More respondents who received two doses of BNT162b2 vaccine showed persistent symptoms than those in the other groups. Disease severity and female sex were identified as potential determinants of the development and persistency of such symptoms.

Conclusion:

Post-COVID neuropsychiatric symptoms were present in considerable percentages of the study participants with SARS-CoV-2 infection, persisting for >6 months in up to 7.6% of the participants.

Keywords

Post-COVID-19neuropsychiatrySARS-COV-2long haulers
Type
Original Article
Information
Acta Neuropsychiatrica , Volume 34 , Issue 6 , December 2022 , pp. 318 - 329
Check for updates
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of Scandinavian College of Neuropsychopharmacology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ahmed, MZ, Ahmed, O, Aibao, Z, Hanbin, S, Siyu, L and Ahmad, A (2020) Epidemic of COVID-19 in China and associated psychological problems. Asian Journal of Psychiatry 51, 102092. doi: 10.1016/j.ajp.2020.102092 CrossRefGoogle ScholarPubMed
Alghamdi, AN, Alotaibi, MI, Alqahtani, AS, Al Aboud, D and Abdel-Moneim, AS (2021) BNT162b2 and ChAdOx1 SARS-CoV-2 post-vaccination side-effects among Saudi vaccinees. Frontiers in Medicine (Lausanne), 8, 760047. doi: 10.3389/fmed.2021.760047 CrossRefGoogle ScholarPubMed
Almufarrij, I and Munro, KJ (2021) One year on: an updated systematic review of SARS-CoV-2, COVID-19 and audio-vestibular symptoms. International Journal of Audiology, 60, 935–945. doi: 10.1080/14992027.2021.1896793 CrossRefGoogle ScholarPubMed
Asadi-Pooya, AA, Akbari, A, Emami, A, Lotfi, M, Rostamihosseinkhani, M, Nemati, H, Barzegar, Z, Kabiri, M, Zeraatpisheh, Z, Farjoud-Kouhanjani, M, Jafari, A, Sasannia, F, Ashrafi, S, Nazeri, M, Nasiri, S and Shahisavandi, M (2021) Long COVID syndrome-associated brain fog. Journal of Medical Virology. doi: 10.1002/jmv.27404 Google ScholarPubMed
Beukes, E, Ulep, AJ, Eubank, T and Manchaiah, V (2021) The impact of COVID-19 and the pandemic on tinnitus: a systematic review. Journal of Clinical Medicine, 10, 2763. doi: 10.3390/jcm10132763 CrossRefGoogle ScholarPubMed
Beukes, EW, Baguley, DM, Jacquemin, L, Lourenco, MPCG, Allen, PM, Onozuka, J, Stockdale, D, Kaldo, V, Andersson, G and Manchaiah, V (2020) Changes in tinnitus experiences during the COVID-19 pandemic. Frontiers in Public Health, 8, 592878. doi: 10.3389/fpubh.2020.592878 CrossRefGoogle ScholarPubMed
Brann, DH, Tsukahara, T, Weinreb, C, Lipovsek, M, Van den Berge, K, Gong, B, Chance, R, Macaulay, IC, Chou, H-J, Fletcher, RB, Das, D, Street, K, de Bezieux, HR, Choi, Y-G, Risso, D, Dudoit, S, Purdom, E, Mill, J, Hachem, RA, Matsunami, H, Logan, DW, Goldstein, BJ, Grubb, MS, Ngai, J and Datta, SR (2020) Non-neuronal expression of SARS-CoV-2 entry genes in the olfactory system suggests mechanisms underlying COVID-19-associated anosmia. Science Advances, 6, eabc5801.CrossRefGoogle Scholar
Carfì, A, Bernabei, R and Landi, F (2020) Persistent symptoms in patients after acute COVID-19. JAMA, 324, 603–605. doi: 10.1001/jama.2020.12603 CrossRefGoogle ScholarPubMed
Chirakkal, P, Al Hail, AN, Zada, N and Vijayakumar, DS (2021) COVID-19 and tinnitus. Ear, Nose, & Throat Journal, 100, 160S–162S. doi: 10.1177/0145561320974849 CrossRefGoogle ScholarPubMed
Colizzi, M, Bortoletto, R, Silvestri, M, Mondini, F, Puttini, E, Cainelli, C, Gaudino, R, Ruggeri, M and Zoccante, L (2020) Medically unexplained symptoms in the times of COVID-19 pandemic: a case-report. Brain, Behavior, & Immunity - Health, 5, 100073. doi: 10.1016/j.bbih.2020.100073 CrossRefGoogle ScholarPubMed
Davis, HE, Assaf, GS, Mccorkell, L, Wei, H, Low, RJ, Re’em, Y, Redfield, S, Austin, JP and Akrami, A (2021) Characterizing long COVID in an international cohort: 7 months of symptoms and their impact. Available at SSRN 3820561.Google Scholar
Delavari, F, Varzaneh, FN and Rezaei, N (2021) Neurologic manifestations of COVID-19. Advances in Experimental Medicine and Biology, 1318, 343–353. doi: 10.1007/978-3-030-63761-3_20 CrossRefGoogle ScholarPubMed
Ding, H, Yin, S, Cheng, Y, Cai, Y, Huang, W and Deng, W (2020) Neurologic manifestations of nonhospitalized patients with COVID-19 in Wuhan, China. MedCommunication, 1, 253–256. doi: 10.1002/mco2.13 Google ScholarPubMed
Eken, HN, Dee, EC, Powers, AR and Jordan, A (2021) Racial and ethnic differences in perception of provider cultural competence among patients with depression and anxiety symptoms: a retrospective, population-based, cross-sectional analysis. Lancet Psychiatry, 8, 957–968. doi: 10.1016/s2215-0366(21)00285-6 CrossRefGoogle ScholarPubMed
Ellul, MA, Benjamin, L, Singh, B, Lant, S, Michael, BD, Easton, A, Kneen, R, Defres, S, Sejvar, J and Solomon, T (2020) Neurological associations of COVID-19. The Lancet. Neurology, 19, 767–783. doi: 10.1016/S1474-4422(20)30221-0 CrossRefGoogle ScholarPubMed
Franceschini, C, Musetti, A, Zenesini, C, Palagini, L, Scarpelli, S, Quattropani, MC, Lenzo, V, Freda, MF, Lemmo, D, Vegni, E, Borghi, L, Saita, E, Cattivelli, R, De Gennaro, L, Plazzi, G, Riemann, D and Castelnuovo, G (2020) Poor sleep quality and its consequences on mental health during the COVID-19 lockdown in Italy. Frontiers in Psychology, 11, 574475. doi: 10.3389/fpsyg.2020.574475 CrossRefGoogle ScholarPubMed
Fraser, E (2020) Long term respiratory complications of covid-19. BMJ, 370, m3001. doi: 10.1136/bmj.m3001 CrossRefGoogle ScholarPubMed
Gao, J, Zheng, P, Jia, Y, Chen, H, Mao, Y, Chen, S, Wang, Y, Fu, H and Dai, J (2020) Mental health problems and social media exposure during COVID-19 outbreak. PloS One, 15, e0231924. doi: 10.1371/journal.pone.0231924 CrossRefGoogle ScholarPubMed
Goldstein Ferber, S, Shoval, G, Zalsman, G, Mikulincer, M and Weller, A (2021) Between action and emotional survival during the COVID-19 era: sensorimotor pathways as control systems of Transdiagnostic anxiety-related intolerance to uncertainty. Frontiers in Psychiatry, 12, 680403. doi: 10.3389/fpsyt.2021.680403 CrossRefGoogle ScholarPubMed
Graham, EL, Clark, JR, Orban, ZS, Lim, PH, Szymanski, AL, Taylor, C, DiBiase, RM, Jia, DT, Balabanov, R, Ho, SU, Batra, A, Liotta, EM and Koralnik, IJ (2021) Persistent neurologic symptoms and cognitive dysfunction in non-hospitalized Covid-19 “long haulers”. Annals of Clinical and Translational Neurology, 8, 1073–1085. doi: 10.1002/acn3.51350 CrossRefGoogle ScholarPubMed
Greenhalgh, T, Knight, M, A’court, C, Buxton, M and Husain, L (2020) Management of post-acute covid-19 in primary care. BMJ, 370, m3026. doi: 10.1136/bmj.m3026 CrossRefGoogle ScholarPubMed
Hampshire, A, Trender, W, Chamberlain, SR, Jolly, AE, Grant, JE, Patrick, F, Mazibuko, N, Williams, SCR, Barnby, JM, Hellyer, P and Mehta, MA (2021) Cognitive deficits in people who have recovered from COVID-19. EClinicalMedicine, 39, 101044.CrossRefGoogle ScholarPubMed
Hoffmann, M, Kleine-Weber, H, Schroeder, S, Krüger, N, Herrler, T, Erichsen, S, Schiergens, TS, Herrler, G, Wu, N-H, Nitsche, A, Müller, MA, Drosten, C and Pöhlmann, S (2020) SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor. Cell, 181, 271–280. e8.CrossRefGoogle ScholarPubMed
Hu, B, Guo, H, Zhou, P and Shi, ZL (2021) Characteristics of SARS-CoV-2 and COVID-19. Nature Reviews Microbiology, 19, 141–154. doi: 10.1038/s41579-020-00459-7 CrossRefGoogle ScholarPubMed
Islam, MK, Molla, MMA, Hasan, P, Sharif, MM, Hossain, FS, Amin, MR and Rahman, MR (2021) Persistence of sleep disturbance among post-COVID patients: findings from a 2-month follow-up study in a Bangladeshi cohort. Journal of Medical Virology. doi: 10.1002/jmv.27397 Google Scholar
Jafari, Z, Kolb, BE and Mohajerani, MH (2021) Hearing loss, tinnitus, and dizziness in COVID-19: a systematic review and meta-analysis. The Canadian Journal of Neurological Sciences. Le journal canadien des sciences neurologiques, 1–12. doi: 10.1017/cjn.2021.63 Google ScholarPubMed
Khan, S and Gomes, J (2020) Neuropathogenesis of SARS-CoV-2 infection. Elife, 9, e59136.CrossRefGoogle ScholarPubMed
Kim, Y, Bitna, H, Kim, SW, Chang, HH, Kwon, KT, Bae, S and Hwang, S (2022) Post-acute COVID-19 syndrome in patients after 12 months from COVID-19 infection in Korea. BMC Infectious Diseases, 22, 93. doi: 10.1186/s12879-022-07062-6 CrossRefGoogle ScholarPubMed
Lamounier, P, Franco Gonçalves, V, Ramos, HVL, Gobbo, DA, Teixeira, RP, Dos Reis, PC, Bahmad, F Jr and Cândido Costa, C (2020) A 67-year-old woman with sudden hearing loss associated with SARS-CoV-2 infection. The American Journal of Case Reports, 21, e927519. doi: 10.12659/AJCR.927519 CrossRefGoogle ScholarPubMed
Lopez-Leon, S, Wegman-Ostrosky, T, Perelman, C, Sepulveda, R, Rebolledo, PA, Cuapio, A and Villapol, S (2021) More than 50 long-term effects of COVID-19: a systematic review and meta-analysis. Available at SSRN 3769978.Google Scholar
Mair, FS and May, CR (2014). Thinking about the burden of treatment. BMJ, 349, g6680. doi: 10.1136/bmj.g6680 CrossRefGoogle ScholarPubMed
Mazurek, B, Boecking, B and Brueggemann, P (2019) Association between stress and tinnitus-new aspects. Otology & Neurotology, 40, e467–e473. doi: 10.1097/mao.0000000000002180 CrossRefGoogle ScholarPubMed
Mazurek, B, Haupt, H, Olze, H and Szczepek, AJ (2012) Stress and tinnitus-from bedside to bench and back. Frontiers in Systems Neuroscience, 6, 47. doi: 10.3389/fnsys.2012.00047 CrossRefGoogle Scholar
Mcardle, N, Ward, SV, Bucks, RS, Maddison, K, Smith, A, Huang, RC, Pennell, CE, Hillman, DR and Eastwood, PR (2020) The prevalence of common sleep disorders in young adults: a descriptive population-based study. Sleep, 43. doi: 10.1093/sleep/zsaa072 Google ScholarPubMed
Mccormack, A, Edmondson-Jones, M, Somerset, S and Hall, D (2016) A systematic review of the reporting of tinnitus prevalence and severity. Hearing Research, 337, 70–79. doi: 10.1016/j.heares.2016.05.009 CrossRefGoogle ScholarPubMed
Moldofsky, H and Patcai, J (2011) Chronic widespread musculoskeletal pain, fatigue, depression and disordered sleep in chronic post-SARS syndrome; a case-controlled study. BMC Neurology, 11, 37. doi: 10.1186/1471-2377-11-37 CrossRefGoogle ScholarPubMed
Park, GC, Bang, SY, Lee, HW, et al. (2022) ACE2 and TMPRSS2 immunolocalization and oral manifestations of COVID-19. Oral Dis. doi: 10.1111/odi.14126 CrossRefGoogle ScholarPubMed
Patone, M, Handunnetthi, L, Saatci, D, Choi, KU, Kim, JM, Shin, S-C, Cheon, Y-I, Sung, E-S, Lee, M, Lee, J-C, Kim, H-S and Lee, B-J (2021) Neurological complications after first dose of COVID-19 vaccines and SARS-CoV-2 infection. Nature Medicine, 27, 2144–2153. doi: 10.1038/s41591-021-01556-7 CrossRefGoogle ScholarPubMed
Rank, A, Tzortzini, A, Kling, E, Schmid, C, Claus, R, Löll, E, Burger, R, Römmele, C, Dhillon, C, Müller, K, Girl, P, Hoffmann, R, Grützner, S and Dennehy, KM (2021) One year after mild COVID-19: the majority of patients maintain specific immunity, but one in four still suffer from long-term symptoms. Journal of Clinical Medicine, 10, 3305.CrossRefGoogle ScholarPubMed
Rubin, R (2020) As their numbers grow, COVID-19 “Long Haulers” stump experts. JAMA, 324, 1381–1383. doi: 10.1001/jama.2020.17709 CrossRefGoogle ScholarPubMed
Schmidt, C (2021) COVID-19 long haulers. Nature Biotechnology, 39, 908–913. doi: 10.1038/s41587-021-00984-7 CrossRefGoogle ScholarPubMed
Seeßle, J, Waterboer, T, Hippchen, T, Simon, J, Kirchner, M, Lim, A, Müller, B and Merle, U (2021) Persistent symptoms in adult patients 1 year after coronavirus disease 2019 (COVID-19): a prospective cohort study. Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America, 74, 1191–1198. doi: 10.1093/cid/ciab611 CrossRefGoogle Scholar
Sønderskov, KM, Dinesen, PT, Santini, ZI and Østergaard, SD (2020) The depressive state of Denmark during the COVID-19 pandemic. Acta Neuropsychiatrica, 32, 226–228. doi: 10.1017/neu.2020.15 CrossRefGoogle ScholarPubMed
Sudre, CH, Murray, B, Varsavsky, T, Graham, MS, Penfold, MS, Bowyer, RC, Pujol, JC, Klaser, K, Antonelli, M, Canas, LS, Molteni, E, Modat, M, Cardoso, MJ, May, A, Ganesh, S, Davies, R, Nguyen, LH, Drew, DA, Astley, CM, Joshi, AD, Merino, J, Tsereteli, N, Fall, T, Gomez, MF, Duncan, EL, Menni, C, Williams, FMK, Franks, PW, Chan, AT, Wolf, J, Ourselin, S, Spector, T and Steves, CJ (2020) Attributes and predictors of long-COVID: analysis of COVID cases and their symptoms collected by the Covid symptoms study app. Medrxiv. doi: 10.1101/2020.10.19.20214494 Google Scholar
Tong, JY, Wong, A, Zhu, D, Fastenberg, JH and Tham, T (2020) The prevalence of olfactory and gustatory dysfunction in COVID-19 patients: a systematic review and meta-analysis. Otolaryngology–Head and Neck Surgery, 163, 3–11. doi: 10.1177/0194599820926473 CrossRefGoogle ScholarPubMed
Troyer, EA, Kohn, JN and Hong, S (2020) Are we facing a crashing wave of neuropsychiatric sequelae of COVID-19? Neuropsychiatric symptoms and potential immunologic mechanisms. Brain, Behavior, and Immunity, 87, 34–39. doi: 10.1016/j.bbi.2020.04.027 CrossRefGoogle ScholarPubMed
Vaira, LA, Lechien, JR, Salzano, G, Salzano, FA, Maglitto, F, Saussez, S and De Riu, G (2020a) Gustatory dysfunction: a highly specific and smell-independent symptom of COVID-19. Indian Journal of Otolaryngology and Head & Neck Surgery, 1–3. doi: 10.1007/s12070-020-02182-4 Google ScholarPubMed
Vaira, LA, Salzano, G, Fois, AG, Piombino, P and De Riu, G (2020b) Potential pathogenesis of ageusia and anosmia in COVID-19 patients. International Forum of Allergy & Rhinology, 10, 1103–1104. doi: 10.1002/alr.22593 CrossRefGoogle ScholarPubMed
Xiong, J, Lipsitz, O, Nasri, F, Lui, LMW, Gill, H, Phan, L, Chen-Li, D, Iacobucci, M, Ho, R, Majeed, A and McIntyre, RS (2020) Impact of COVID-19 pandemic on mental health in the general population: a systematic review. Journal of Affective Disorders, 277, 55–64. doi: 10.1016/j.jad.2020.08.001 CrossRefGoogle ScholarPubMed
Yong, SJ (2021) Persistent Brainstem dysfunction in long-COVID: a hypothesis. ACS Chemical Neuroscience, 12, 573–580. doi: 10.1021/acschemneuro.0c00793 CrossRefGoogle ScholarPubMed