Psychiatric Views on the Daily News - Episode 123

Is COVID-19 the Quintessential Neuropsychiatric Disorder?

What are the neuropsychiatric effects of COVID-19, and how can we study them further?

PSYCHIATRIC VIEWS ON THE DAILY NEWS

A quintessential neuropsychiatric disorder might be one that reflects the variety of ways that the brain and mind can be adversely affected. Neuropsychiatry would consist both of the direct neurological impact of some pathogen on the brain, which is what we used to call “organic,” as well as the psychological reactions to the impact, or what we used to call the “functional.”

At various times, there have been failed attempts to connect neurology and psychiatry into 1 specialty. Certification testing has always overlapped the fields to some degree. Some given examples of neuropsychiatric disorders are traumatic head injury, migraine headaches, menopause, and medication side effects.

Although the major pathology of COVID-19 is respiratory damage, over time it has become clearer that there also are neuropsychiatric ones. I apparently had an acute respiratory episode, but did not notice any neuropsychiatric aspects—that is, until recently, when I experienced more anxiety and uncertainly about how much risk to take outside of the home. I reluctantly decided that coming to the 2022 APA annual meeting next week was too risky.

Around this same time, I ran across a new COVID-19 study out of England.1 The results indicated that new and increased rates of anxiety disorder, dementia, psychosis, and bipolar disorder were occurring. It is unclear how much is the result of the viral pathogen, the psychological response, or both. Some also seem to be associated with long COVID including unexplained mood changes, brain fog, and language difficulties. When the illness is more severe or a loved one dies, posttraumatic stress disorders and prolonged grief disorders are likely to increase. Then there is the conscious and unconscious defense mechanism of denial of the risk we have encountered over the last 2 years.

All of this complexity and uncertainly suggests that COVID-19 would benefit from being studied at academic neuropsychiatric centers, if only more of them existed. In the meanwhile, I would suggest leaning to the safe side for now as the infections, and now even hospitalizations, are increasing.

Dr Moffic is an award-winning psychiatrist who has specialized in the cultural and ethical aspects of psychiatry. A prolific writer and speaker, he received the one-time designation of Hero of Public Psychiatry from the Assembly of the American Psychiatric Association in 2002. He is an advocate for mental health issues relate to climate instability, burnout, Islamophobia, and anti-Semitism for a better world. He serves on the Editorial Board of Psychiatric Times™.

Reference

1. Clift AK, Ranger TA, Patone M, et al. Neuropsychiatric ramifications of severe COVID-19 and other server acute respiratory infections. JAMA Psychiatry. May 11, 2022. Online ahead of print.