1
|
Vasilevska V, Guest PC, Szardenings M, Benros ME, Steiner J. Possible temporal relationship between SARS-CoV-2 infection and anti-NMDA receptor encephalitis: a meta-analysis. Transl Psychiatry 2024; 14:139. [PMID: 38459000 PMCID: PMC10923949 DOI: 10.1038/s41398-024-02831-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 02/07/2024] [Accepted: 02/13/2024] [Indexed: 03/10/2024] Open
Abstract
The global impact of SARS-CoV-2 infection has raised concerns about secondary diseases beyond acute illness. This review explores the significance and potential underlying mechanisms of how SARS-CoV-2 infection might elicit an immune response targeting N-methyl-D-aspartate (NMDA) receptors, and its implications for autoimmune-driven neuropsychiatric manifestations. We identified 19 published case reports of NMDA receptor encephalitis associated with SARS-CoV-2 infection or vaccination by a systematic literature search. The significance of these reports was limited since it is not clear if a coincidental or causal relationship exists between SARS-CoV-2 infection or vaccination and manifestation of NMDA receptor encephalitis. The included studies were hampered by difficulties in establishing if these patients had pre-existing NMDA receptor antibodies which entered the brain by infection- or vaccination-associated transient blood-brain barrier leakage. In addition, four cases had comorbid ovarian teratoma, which is a known trigger for development of NMDA receptor encephalitis. Considering that billions of people have contracted COVID-19 or have been vaccinated against this virus, the publication of only 19 case reports with a possible link to NMDA receptor encephalitis, indicates that it is rare. In conclusion, these findings do not support the case that SARS-CoV-2 infection or vaccination led to an increase of existing or de novo encephalitis mediated by an autoimmune response targeting NMDA receptor function. Nevertheless, this work underscores the importance of ongoing vigilance in monitoring viral outbreaks and their potential impact on the central nervous system through basic, epidemiological and translational research.
Collapse
Affiliation(s)
- Veronika Vasilevska
- Department of Psychiatry, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
- Laboratory of Translational Psychiatry, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Paul C Guest
- Department of Psychiatry, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
- Laboratory of Translational Psychiatry, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
- Laboratory of Neuroproteomics, Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Michael Szardenings
- Ligand Development Unit, Fraunhofer Institute of Cell Therapy and Immunology, Leipzig, Germany
| | - Michael E Benros
- Copenhagen Research Centre for Mental Health, Mental Health Center Copenhagen, Copenhagen University Hospital, Hellerup, Denmark
| | - Johann Steiner
- Department of Psychiatry, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany.
- Laboratory of Translational Psychiatry, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany.
- Center for Behavioral Brain Sciences (CBBS), Magdeburg, Germany.
- Center for Health and Medical Prevention (CHaMP), Magdeburg, Germany.
- German Center for Mental Health (DZPG), Partner Site Halle-Jena-Magdeburg, Magdeburg, Germany.
- Center for Intervention and Research on Adaptive and Maladaptive Brain Circuits Underlying Mental Health (C-I-R-C), Halle-Jena-Magdeburg, Magdeburg, Germany.
| |
Collapse
|
2
|
Lucijanic D, Mihaljevic Peles A, Piskac Zivkovic N, Lucijanic M, Kranjcevic M, Muzinic Marinic L. Relationship of Anxiety, Depression, Stress, and Post-Traumatic Stress Disorder Symptoms with Disease Severity in Acutely Ill Hospitalized COVID-19 Patients. Behav Sci (Basel) 2023; 13:734. [PMID: 37754012 PMCID: PMC10525712 DOI: 10.3390/bs13090734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 08/27/2023] [Accepted: 08/28/2023] [Indexed: 09/28/2023] Open
Abstract
We aimed to investigate depression, anxiety, stress, and PTSD symptoms and their relationship with disease severity in acutely ill hospitalized Coronavirus disease 2019 (COVID-19) patients. A single-center cross-sectional observational survey study screening for psychiatric symptoms using the Depression, Anxiety and Stress Scale-21 Items (DASS-21) and the Impact of Events Scale-Revised (IES-R) questionnaires was performed including a total of 169 acutely ill COVID-19 patients. All patients were adults and of white race and developed respiratory insufficiency during hospitalization. Demographic, clinical and laboratory data were evaluated as predictors of psychiatric symptoms. We hypothesized that higher intensity of COVID-19 symptoms and higher oxygen requirement would be associated with occurrence of depression, anxiety, stress, and PTSD symptoms. Depressive symptoms were absent in 29%, mild in 16%, moderate in 27.8%, severe in 10.7% and extremely severe in 16.6% patients. Anxiety symptoms were absent in 43.8%, mild in 6.5%, moderate in 17.2%, severe in 5.3% and extremely severe in 27.2% patients. Stress symptoms were absent in 78.7%, mild in 4.7%, moderate in 7.1%, severe in 7.7%, and extremely severe in 1.8% patients. A total of 60.9% patients had no PTSD symptoms, 16% had undiagnosed symptoms, and 23.1% met the criteria for a PTSD diagnosis. All psychiatric symptoms were more pronounced in female patients, depression and anxiety symptoms were associated with prior chronic obstructive pulmonary disease. Only depressive symptoms were significantly associated with higher intensity of COVID-19 symptoms and higher oxygen requirement. Acutely ill hospitalized COVID-19 patients presented a high prevalence of emergent psychiatric sequelae, especially in females, and more severe COVID-19 influenced mostly the severity of depressive symptoms.
Collapse
Affiliation(s)
- Dijana Lucijanic
- Department of Psychiatry, Referral Centre for Stress-Related Disorders of the Ministry of Health, Centre University Hospital Dubrava, Avenija Gojka Šuška 6, 10000 Zagreb, Croatia
| | - Alma Mihaljevic Peles
- Clinical Hospital Centre Zagreb, Psychiatric Clinic, Kispaticeva 12, 10000 Zagreb, Croatia
- Department for Chemistry and Biochemistry, School of Medicine, Salata 3, 10000 Zagreb, Croatia
| | | | - Marko Lucijanic
- Hematology Department, University Hospital Dubrava, Av. Gojka Suska 6, 10000 Zagreb, Croatia
- School of Medicine, University of Zagreb, Salata 3, 10000 Zagreb, Croatia
| | - Matija Kranjcevic
- Department of Psychiatry, Referral Centre for Stress-Related Disorders of the Ministry of Health, Centre University Hospital Dubrava, Avenija Gojka Šuška 6, 10000 Zagreb, Croatia
| | - Lana Muzinic Marinic
- Department of Psychiatry, Referral Centre for Stress-Related Disorders of the Ministry of Health, Centre University Hospital Dubrava, Avenija Gojka Šuška 6, 10000 Zagreb, Croatia
- University of Applied Health Sciences in Zagreb, Mlinarska Street 38, 10000 Zagreb, Croatia
| |
Collapse
|
3
|
Ashtari S, Rahimi-Bashar F, Karimi L, Salesi M, Guest PC, Riahi MM, Vahedian-Azimi A, Sahebkar A. Psychological Distress Impact of Coronavirus Disease (COVID-19) Outbreak on Three Continents: A Systematic Review and Meta-analysis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1412:73-95. [PMID: 37378762 DOI: 10.1007/978-3-031-28012-2_4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
BACKGROUND The dire state of coronavirus disease (COVID-19) outbreak has had a substantial psychological impact on society. METHODS A systematic search was performed through Medline, PubMed, Embase, Scopus, and Web of Science, to investigate the impact of the COVID-19 pandemic on the psychological health of individuals in various countries. Subgroup analyses considered gender and classification of countries into three continents of America, Europe, and Asia. Only studies that used the COVID-19 Peritraumatic Distress Index (CPDI) questionnaire as a tool to assess mental distress were included in this meta-analysis. Heterogeneity among studies was assessed by I2 statistic, and the random-effects model was utilized to obtain the pooled prevalence. RESULTS This pooled analysis included a large data sample of 21 studies consisting of 94,414 participants. The pooled prevalence of the psychological distress during the time of COVID-19 pandemic by CPDI for the continent of Asia was 43% (34.6% mild-to-moderate and 8.4% severe) which was greater than that for Europe (35%; 30% mild-to-moderate and 5% severe) but lower than that for America (64.3%; 45.8% mild to moderate and 18.5% severe). In addition, the prevalence of psychological distress according to CPDI was higher in females (48%; 40% mild to moderate, 13% severe) compared with males (59%; 36% mild to moderate and 5% severe). CONCLUSIONS Our findings suggest that psychological distress in the Americas is a larger problem than in Asia and European continents. Females appear to be more vulnerable and may therefore require further attention in terms of preventive and management strategies. Implementation of both digital and molecular biomarkers is encouraged to increase objectivity and accuracy of assessing the dynamic changes in mental health in the current and future pandemics.
Collapse
Affiliation(s)
- Sara Ashtari
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farshid Rahimi-Bashar
- Department of Anesthesiology and Critical Care, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Leila Karimi
- Behavioral Sciences Research Center, LifeStyle Institute, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mahmood Salesi
- Chemical Injuries Research Center, life style institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Paul C Guest
- Department of Psychiatry, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
- Laboratory of Translational Psychiatry, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
- Laboratory of Neuroproteomics, Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Maryam Matbou Riahi
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amir Vahedian-Azimi
- Trauma Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran.
| | - Amirhossein Sahebkar
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Biotechnology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| |
Collapse
|
4
|
Delpino FM, da Silva CN, Jerônimo JS, Mulling ES, da Cunha LL, Weymar MK, Alt R, Caputo EL, Feter N. Prevalence of anxiety during the COVID-19 pandemic: A systematic review and meta-analysis of over 2 million people. J Affect Disord 2022; 318:272-282. [PMID: 36096370 PMCID: PMC9462928 DOI: 10.1016/j.jad.2022.09.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/28/2022] [Accepted: 09/05/2022] [Indexed: 12/02/2022]
Abstract
INTRODUCTION Uncertainty, disruptions in daily routines, and concerns for the health and well-being during the COVID-19 pandemic are likely associated with increases in generalized anxiety. The present study aimed to systematically review the literature in order to identify the update prevalence of anxiety in the general population during the COVID-19 pandemic. METHODS A systematic review and meta-analysis. It included studies that assessed the prevalence of anxiety among the general population during the COVID-19 pandemic. RESULTS In total, we included 194 studies. The general prevalence of anxiety was 35.1 %, affecting approximately 851,000 participants. The prevalence in low and middle-income countries (35.1 %; 95%CI: 29.5 % to 41.0 %) was similar compared to high-income countries (34.7 %; 95%CI: 29.6 % to 40.1 %). In studies that provided the proportion of cases in each level of anxiety disorder, mild-to-moderate anxiety affected one quarter of the participants. One in ten cases with anxiety during the COVID-19 may be living with severe or extremely anxiety disorder. Most instruments estimated similar prevalence of anxiety disorders with notable difference in the prevalence estimated by the Generalized Anxiety Disorder 2-item (GAD-2), Zung Self-Rating Anxiety Scale (SAS), and State-Trait Anxiety Inventory (STAI). CONCLUSION One in three adults were living with anxiety disorder during the COVID-19 pandemic worldwide.
Collapse
Affiliation(s)
- Felipe Mendes Delpino
- Postgraduate Program in Nursing, Federal University of Pelotas, Rio Grande do Sul, Brazil.
| | | | - Jeferson Santos Jerônimo
- Postgraduate Program in Physical Education, Federal University of Pelotas, Rio Grande do Sul, Brazil
| | - Eliete Stark Mulling
- Postgraduate Program in Physical Education, Federal University of Pelotas, Rio Grande do Sul, Brazil
| | - Larissa Leal da Cunha
- Postgraduate Program in Physical Education, Federal University of Pelotas, Rio Grande do Sul, Brazil
| | - Marina Krause Weymar
- Postgraduate Program in Physical Education, Federal University of Pelotas, Rio Grande do Sul, Brazil
| | - Ricardo Alt
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Rio Grande do Sul, Brazil
| | - Eduardo L. Caputo
- Postgraduate Program in Physical Education, Federal University of Pelotas, Rio Grande do Sul, Brazil
| | - Natan Feter
- Postgraduate Program in Epidemiology, Federal University of Rio Grande do Sul, Rio Grande do Sul, Brazil
| |
Collapse
|
5
|
Colzato L, Zhang W, Walter H, Beste C, Stock AK. An Oppositional Tolerance Account for Potential Cognitive Deficits Caused by the Discontinuation of Antidepressant Drugs. PHARMACOPSYCHIATRY 2021; 54:252-260. [PMID: 34293810 PMCID: PMC8575552 DOI: 10.1055/a-1520-4784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 05/26/2021] [Indexed: 10/24/2022]
Abstract
Depression is the leading cause of disability worldwide, making antidepressant drugs the most used psychiatric drugs in the USA. Withdrawal effects and rebound symptoms frequently occur after the reduction and/or discontinuation of these drugs. Although these phenomena have been investigated with respect to the clinical symptomatology, no studies have systematically investigated the effects of withdrawal/rebound on general cognition. We present a novel framework based on the idea of allostatic adaptation, which allows to predict how different antidepressants likely impair different cognitive processes as a result of withdrawal and rebound effects. This framework relies on the assumptions that the type of cognitive impairments evoked by an antidepressant is determined by the targeted neurotransmitter systems, while the severity of deficits depends on its half-life. Our model predicts that the severity of detrimental cognitive withdrawal and rebound effects increases with a shorter half-life of the discontinued antidepressant drug. It further proposes drug-specific effects: antidepressants mainly targeting serotonin should primarily impair aversive and emotional processing, those targeting norepinephrine should impair the processing of alerting signals, those targeting dopamine should impair motivational processes and reward processing, and those targeting acetylcholine should impair spatial learning and memory. We hope that this framework will motivate further research to better understand and explain cognitive changes as a consequence of antidepressant discontinuation.
Collapse
Affiliation(s)
- Lorenza Colzato
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Dresden, Germany
- Department of Cognitive Psychology, Institute of Cognitive Neuroscience, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
- Cognitive Psychology, Faculty of Psychology, Shandong Normal University, Jinan, China
| | - Wenxin Zhang
- Cognitive Psychology, Faculty of Psychology, Shandong Normal University, Jinan, China
| | - Henrik Walter
- Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Christian Beste
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Dresden, Germany
- Cognitive Psychology, Faculty of Psychology, Shandong Normal University, Jinan, China
| | - Ann-Kathrin Stock
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Dresden, Germany
- Biopsychology, Faculty of Psychology, TU Dresden, Dresden, Germany
| |
Collapse
|