Hello, From the Other Side: Psychiatric Complications in a Future Postpandemic World

Psychiatric Times' Editor in Chief shared some insights and data on the psychiatric impacts of COVID-19, and what we might expect in the future.

CONFERENCE REPORTER

We all know psychiatry, and the health care field at large, have been greatly impacted by the COVID-19 pandemic, but John J. Miller, MD, Editor in Chief of Psychiatric TimesTM, shared a little bit more about how psychiatry will be impacted in a postpandemic world during his presentation at the 2021 Annual Psychiatric TimesTM World CME Conference.

“This virus has impacted virtually everybody,” said Miller wistfully. “The health effects of the individual who’s infected. The effects on family and friends of the infected individual. Individuals who modify their life in many ways because of a fear of getting infected. The stress, the unknown, the guilt, the anxiety of first responders. Health care providers often with overwhelming situations and not enough staff and too many patients.”

Miller shared a range of psychiatric symptoms that can occur directly due to COVID-19, as published in the American Journal of Psychiatry in early 2021. The list includes anxiety, depression, insomnia, fear, grief, phobias, posttraumatic stress disorder, social avoidance, increased substance abuse, suicidality, psychosis, and obsessive compulsive disorder.1

He also shared a list specific to children and adolescents, based on a study published in JAMA Pediatrics.2 Out of 29 studies and 81,000 participants, 25% had clinically elevated depression, 20% had clinically elevated anxiety, and it was estimated that the degree of depression and anxiety in older children was double that of what would be expected prepandemic.

An Attack on the Brain

More disturbingly, Miller shared that COVID-19 could have a more direct effect: “This is clearly in the early stages of understanding, but based on what is out there now, we do know that it appears the virus can directly attack the brain.”

The Sars-COV-2 virus can access the brain through 3 tracks: the olfactory tract, the vagus nerve, or the trigeminal nerve, Miller explained. If Sars-COV-2 traverses the olfactory mucosa, it can cause the loss of smell while gaining access to the brain.

Miller shared a number of ways the virus can damage the brain. Damage to endothelial cells that abut the brain can lead to inflammation in thrombi and thus cause direct damage to the brain. Astrocytes, the primary type of brain cell affected, play an important role in brain fog and fatigue. Also well known is the neuroinflammation caused by COVID-19, which can cause an aggressive, systemic cytokine storm in serious COVID-19 infections. This storm can damage the blood brain barrier and make it more permeable, allowing in more cells and potential active viruses. Furthermore, Miller shared, cytokines in the brain can activate microglia and enact astrocytes, which put a further stress on the brain and can result in damage.

“In an ideal situation, there would be a recovery. But sometimes there’s a partial recovery, and other times, there's no recovery, such as if there was a subsequent stroke,” Miller added.

Other Concerns

Substance abuse is another of Miller’s concerns with COVID-19. The stress, trauma, and grief, compounded by a reduced access to substance use disorder treatments, caused a rise in drug overdose deaths with more than 92,000 deaths according to the National Center for Health Statistics.3 

Furthermore, the antivaccine movement poses a significant threat to the safety of the general populous, Miller fears, as compounded by the editorial written by Joseph Goldberg, MD, featured in the Journal of Clinical Psychiatry.4 Miller called it “mass hysteria.”

“When these mass groups with mass hysteria mistrust, or frankly develop pure paranoia and the secondary behaviors intrude into the realm of public safety, society needs to engage in a serious ethical debate as to what actions should be taken to protect the harm or risk to the many from the distortions, actions, or lack thereof, of from the few,” said Miller.

Concluding Thoughts

Miller called COVID a “modern medical challenge of the first order,” as described by authors in a Lancet editorial,5 one we anticipate will continue affecting psychiatry and the health care field as a whole for many years to come.

As to recommendations, Miller suggested individuals get vaccinated, educate others compassionately and accurately, and increase the number of vaccines available to the global community—that way, everyone can be safe.

Are you interested in hearing more like this? There’s still time to register for the 2021 Annual Psychiatric TimesTM World CME Conference!

References

1. Kalin NH. COVID-19 and stress-related disorders. Am J Psychiatry. 2021;178(6):471-474.

2. Racine N, McArthur BA, Cooke JE, et al. Global prevalence of depressive and anxiety symptoms in children and adolescents during COVID-19: a meta-analysis. JAMA Pediatr. 2021;e212482.

3. Rossen LM, Ahmad FB, Anderson RN, et al. Disparities in excess mortality associated with COVID-19 - United States, 2020. MMWR Morb Mortal Wkly Rep. 2021;70(33):1114-1119.

4. Goldberg JF. How should psychiatry respond to COVID-19 anti-vax attitudes? J Clin Psychiatry. 2021;82(5):21ed14213.

5. The Lancet. Understanding long COVID: a modern medical challenge. Lancet. 2021;398(10302):725.