First UK study of COVID-19 neurological and psychiatric complications warns of mental health problems in younger patients
A study of 153 patients treated in UK hospitals during the acute phase of the COVID-19 pandemic describes a range of neurological and psychiatric complications that may be linked to the virus.
The research carried out by the CoroNerve Studies Group, including the Royal College of Psychiatrists, and published today in The Lancet Psychiatry journal reveals that while stroke was the most commonly reported neurological complication in hospitalised COVID-19 patients, many younger patients developed an altered mental state such as psychosis or catatonia.
To investigate the breadth of COVID-19 complications that affect the brain, researchers set up a secure, UK-wide online network for specialist doctors to report details of specific cases. These portals were hosted by professional bodies representing specialists in neurology, stroke, psychiatry and intensive care. Data was collected between 2 April and 26 April 2020, during the exponential phase of the pandemic.
During these three weeks, the researchers identified cases from across the UK who had both a new COVID-19 diagnosis and a new neurological or psychiatric diagnosis. All of the patients included in the study were selected for inclusion by expert doctors and therefore likely represent the most severe cases.
The median age of the patients was 71 (23-94) years. Of the 125 patients for whom complete clinical data was available, 57 (44%) suffered ischemic strokes and 39 (31%) experienced an altered mental state reflecting both neurological and psychiatric diagnoses. Whereas 61 (82%) of cases of cerebrovascular events occurred in those over 60 years old, half of cases with an altered mental state were under 60 years old.
The findings should help to direct future research to establish the mechanisms of such complications so that potential treatments can be developed.
Dr Benedict Michael, from the University of Liverpool and senior author on the paper, said:
“Whilst an altered mental state was being reported by some clinicians, we were surprised to identify quite so many cases, particularly in younger patients, and by the breadth of clinical syndromes ranging from brain inflammation (encephalitis) through to psychiatric presentations.”
“Clinicians should be alert to the possibility of patients with COVID-19 developing these complications and, conversely, of the possibility of COVID-19 in patients presenting with acute neurological and psychiatric syndromes.”
Larger studies are now needed to identify COVID-19 patients both in and outside of hospitals, to estimate prevalence of these complications and also those at risk of developing them.
Dr Tim Nicholson and Dr Tom Pollak from the Institute of Psychiatry, Psychology and Neuroscience at King’s College London led the Royal College of Psychiatristy’s’ surveillance as part of the CoroNerve Studies Group. Dr Nicholson said:
“The first data from the UK’s CoroNerve project give us an important first look at the psychiatric disorders caused by COVID-19. Psychiatrists have reported a wide range of mental health complications in coronavirus patients − from mood disorders, such as mania or depression, to psychosis and more complex conditions such as cognitive problems and catatonia.
“While more research is needed to understand how long these symptoms last and how best to treat them, mental health services need to start preparing urgently to support people experiencing mental illness following COVID-19.”
Dr Pollak, who has studied psychiatric features of past pandemics, added:
“Since the 1918 Spanish influenza pandemic we have known that pandemic viral infections can have serious psychiatric consequences, so there was some reason to expect we might see something similar with COVID-19.
"This is the first evidence demonstrating that psychiatric disorders like psychosis, neurocognitive disorders and catatonia can be seen following COVID-19, alongside other kinds of brain illnesses.”
“It isn’t possible yet to say whether these represent the direct effects of the virus on the brain, or of general inflammation in the body, or even some sort of overactive immune response. And we shouldn’t forget that, during a pandemic, anxiety and even paranoia are ever-present, and the mental health effects of hospitalisation, isolation, social distancing and loss of loved ones could also contribute to psychiatric disorders.”
Professor Eileen Joyce, Chair of the Faculty of Neuropsychiatry and Professor Alan Carson, Executive Member of the Faculty of Neuropsychiatry at the Royal College of Psychiatrists were key members of the working group that set up the surveillance system.
As well as the Royal College of Psychiatrists The CoroNerve Studies Group is supported by the Association of British Neurologists, British Association of Stroke Physicians, British Paediatric Neurology Association, and intensive care societies, including the NeuroAnaesthesia and Critical Care Society, and the Encephalitis Society.
The researchers are supported by grants from the Medical Research Council, Wellcome, National Institute of Health Research and Academy of Medical Sciences.