COVID-19 and its impact on neurological manifestations and mental health: the present scenario

Unraveling the Role of the Blood-Brain Barrier in the Pathophysiology of Depression: Recent Advances and Future Perspectives

Depression is a highly prevalent psychological disorder characterized by persistent dysphoria, psychomotor retardation, insomnia, anhedonia, suicidal ideation, and a remarkable decrease in overall well-being. Despite the prevalence of accessible antidepressant therapies, many individuals do not achieve substantial improvement. Understanding the multifactorial pathophysiology and the heterogeneous nature of the disorder could lead the way toward better outcomes. Recent findings have elucidated the substantial impact of compromised blood-brain barrier (BBB) integrity on the manifestation of depression. BBB functions as an indispensable defense mechanism, tightly overseeing the transport of molecules from the periphery to preserve the integrity of the brain parenchyma. The dysfunction of the BBB has been implicated in a multitude of neurological disorders, and its disruption and consequent brain alterations could potentially serve as important factors in the pathogenesis and progression of depression. In this review, we extensively examine the pathophysiological relevance of the BBB and delve into the specific modifications of its components that underlie the complexities of depression. A particular focus has been placed on examining the effects of peripheral inflammation on the BBB in depression and elucidating the intricate interactions between the gut, BBB, and brain. Furthermore, this review encompasses significant updates on the assessment of BBB integrity and permeability, providing a comprehensive overview of the topic. Finally, we outline the therapeutic relevance and strategies based on BBB in depression, including COVID-19-associated BBB disruption and neuropsychiatric implications. Understanding the comprehensive pathogenic cascade of depression is crucial for shaping the trajectory of future research endeavors.

Identifying cerebral microstructural changes in patients with COVID-19 using MRI: A systematic review

Coronavirus disease 2019 (COVID-19) is an epidemic viral disease caused by a novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Despite the excessive number of neurological articles that have investigated the effect of COVID-19 on the brain from the neurological point of view, very few studies have investigated the impact of COVID-19 on the cerebral microstructure and function of the brain. The aim of this study was to summarize the results of the existing studies on cerebral microstructural changes in COVID-19 patients, specifically the use of quantitative volumetric analysis, blood oxygen level dependent (BOLD), and diffusion tensor imaging (DTI). We searched PubMed/MEDLINE, ScienceDirect, Semantic Scholar, and Google Scholar from December 2020 to April 2022. A well-constructed search strategy was used to identify the articles for review. Seven research articles have met this study's inclusion and exclusion criteria, which have applied neuroimaging tools such as quantitative volumetric analysis, BOLD, and DTI to investigate cerebral microstructure changes in COVID-19 patients. A significant effect of COVID-19 was found in the brain such as hypoperfusion of cerebral blood flow, increased gray matter (GM) volume, and reduced cortical thickness. The insula and thalamic radiation were the most frequent GM region and white matter tract, respectively, that are involved in SARS-CoV-2. COVID-19 was found to be associated with changes in cerebral microstructures. These abnormalities in brain areas might lead to be associated with behaviors, mental and neurological alterations that need to be considered carefully in future studies.

New-onset psychosis following COVID-19 infection in a patient with no psychiatric history: A longitudinal case report

Background

Viral infection, including COVID-19, has been implicated as a potential cause of various neurobehavioral issues. An increasing number of case reports suggest that current or recent COVID-19 infection may cause new onset of psychotic symptoms in some individuals, potentially related to viral inflammation or infection of the nervous system.

Case presentation

A 26-year-old woman with no psychiatric history presented with severe psychotic symptoms days after recovery from a mild COVID-19 infection. No other etiologies for psychosis were identified via diagnostic testing, review of medical history, or interviews with family. Her symptoms persisted for approximately two months, requiring three inpatient admissions, various medication trials, and ongoing outpatient follow-up. With continued use of quetiapine and lithium, she returned to living independently and working full-time, and discontinued all medication approximately nine months after symptom onset.

Conclusion

The psychiatric and cognitive effects of COVID-19 infection are not yet fully understood. Given the widespread and ongoing nature of this pandemic, this remains an important focus of further investigation, especially within the context of potential long-term complications.

In silico Analysis of ACE2 Receptor to Find Potential Herbal Drugs in COVID-19 Associated Neurological Dysfunctions

COVID-19 mainly causes the collapse of the pulmonary system thereby causing a dearth of oxygen in the human body. Patients infected with this viral disease have been reported to experience various signs and symptoms associated with brain dysfunction, from the feeling of vagueness to loss of smell and taste to severe strokes. These neurological problems have been reported by younger COVID-19 infected patients mainly in their thirties and forties. Various researchers from around the globe have discerned numerous other brain dysfunctions, such as headache, dizziness, numbness, major depressive disorder, anosmia, encephalitis, febrile seizures, and Guillain-Barre syndrome. The involvement of the CNS by this viral infection has been predicted to be for a longer period of time, even if the patient recovers from COVID-19. The neuronal cell damage caused by COVID-19 is a potent factor responsible for cognitive, behavioral, and psychological problems among its sufferers. The hypoxic conditions can also trigger the formation of beta-amyloid plaques and tau-tangles and thus the virus can even induce Alzheimer’s in patients in the near future. The virus affects the brain directly, thereby causing encephalitis. This pandemic has also been shown to have a negative psychological toll on people. This research aims to highlight the brain dysfunction associated with the ACE2 receptor that is known to be a crucial player in the COVID-19 pandemic using genetic networking approaches. Furthermore, we have identified herbal drug candidates that bind to the ACE2 receptor in order to identify potential treatments for the neurological manifestations of COVID-19.

Mental Health Outcomes and Sleep Status among Patients with Coronavirus Disease 2019

Objective: The immediate impacts of coronavirus disease 2019 (COVID-19) on mental health of affected patients and psychiatric morbidities of these patients has been neglected by researchers. We assessed mental health outcomes and sleep status among inpatients and outpatients with COVID-19 who were initially referred to our COVID-19 clinic in Mashhad, Iran during April-October 2020. Method : In this ethically approved cross-sectional study, 130 patients with confirmed COVID-19 who were referred to outpatient clinics and wards of a referral hospital in Mashhad, Iran were surveyed during April-October 2020. Demographic data were collected after obtaining informed written consent. Validated Persian versions of insomnia severity index (ISI), 9-item patient health questionnaire (PHQ-9), and 7-item generalized anxiety disorder (GAD-7) and revised impact of event scale (IES-R) were used as main outcome measures (i.e. status of anxiety, depression, insomnia, and event-related distress). Analysis was performed with SPSS using binary logistic regression. P-values < 0.05 were considered significant. Results: Overall, 65 inpatients and 65 outpatients were surveyed. The two groups did not significantly defer in terms of insomnia and depression severity, but the outpatients showed higher levels of anxiety (52.3% vs. 24.6%, P = 0.005) and distress compared to inpatients (80.0% vs. 64.6%, P < 0.001). Male sex (OR = 0.017, 95%CI = 0.000-0.708, P = 0.032) exhibited independent and inverse association with depression in COVID-19 patients. Being married (OR = 0.102, 95% CI = 0.018-0.567, P = 0.009) was independently and inversely associated with anxiety. Insomnia was independently associated with event-related distress (OR = 7.286, 95%CI = 2.017-26.321, P = 0.002). Only depression was independently associated with insomnia (OR = 49.655, 95%CI = 2.870-859.127, P = 0.007). Conclusion: We found symptoms of psychological distress and anxiety to be more prevalent among outpatients with COVD-19 than inpatients. Insomnia can be a potential risk factor for adverse mental health outcomes in these patients.

COVID-19 Induced New-onset Psychosis: A Case Report from Oman

Neurobehavioral impairment associated with COVID-19 infection has been recently documented in the literature. COVID-19 infection has also been associated with an increased risk for developing psychiatric symptoms, including rare reports on psychosis. We report a case of a 46-year-old male with no significant medical, family, and psychiatric history admitted to the hospital with COVID-19-related psychosis. Possible contributory factors for his condition are discussed, including the relationship between infections and the brain circuitry, inadvertent iatrogenic effects of pharmaceuticals used to manage COVID-19, as well as diathesis-stress associated with the tribulation of the prevailing pandemic.

Cognitive, behavioral, and psychological manifestations of COVID-19 in post-acute rehabilitation setting: preliminary data of an observational study

Psychological, emotional, and behavioral domains could be altered in COVID-19 patients and measurement of variables within these domains seems to be mandatory. Neuropsychological assessment could detect possible cognitive impairment caused by COVID-19 and the choice of appropriate tools is an important question. Aim of this exploratory study was to verify the effectiveness of an assessment model for patients with COVID-19. Twelve patients were enrolled and tested with Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Anxiety and Depression Short Scale (AD-R), and the Neuropsychiatry Inventory (NPI), at the time of their entrance (T0) and discharge (T1) from a rehabilitative unit. Moreover, a follow-up evaluation after 3 months (T2) has been conducted on eight patients. Results showed that at baseline (T0), 58.3% of the patients reported a score below cut-off at MMSE and 50% at MoCA. Although a significant amelioration was found only in NPI scores, a qualitative improvement has been detected at all tests, except for MoCA scores, in the T0-T1 trend analysis. A one-way repeated measures analysis of variance showed a significant variation in AD-R depression score, considering the three-assessment time (T0, T1, and T2). The evaluation and tracking over time of the impact of COVID-19 on cognitive, psychological, and behavioral domains has relevant implications for rehabilitation and long-term assistance needs planning. The choice of assessment tools should consider patients vulnerability and match the best compromise among briefness, sensitivity, and specificity.

[Neuropsychiatric Aspects of COVID-19 - A Narrative Overview]

The SARS-CoV-2 virus (Severe Acute Respiratory Syndrome Coronavirus Type 2) and COVID-19 (Coronavirus Disease 2019) can affect numerous organ systems. In the present paper we offer an overview of the current state of knowledge about the psychiatric aspects of SARS-CoV-2 infection.Medline, Embase und LIVIVO were searched for relevant literature, the last query dating from March 2nd, 2021. Different stress factors in the context of the pandemic can lead to manifest mental illnesses. In addition, there is a risk of neuropsychological changes due to the biological effects of the virus itself.Our work describes the psychological symptoms of COVID-19 sufferers themselves and the psychological effects of the epidemic and the associated socio-economic and psychosocial stress factors on those who are not sick.The most common psychiatric complication among people with COVID-19 is delirium, while hospitalized patients seem to have an increased incidence of symptoms of anxiety, depression and PTSD. There are many case reports on psychotic disorders. In general, an existing psychiatric illness (especially dementia and psychotic disorders) also increases the risk of infection and of a more severe course of the disease. After recovery from COVID-19 infection, there is also a higher incidence of mental illnesses, in particular "Chronic Post-SARS Syndrome" with its manifestations such as fatigue, anxiety, depression and PTSD. In addition, the course of dementia seems to be negatively influenced by an infection with SARS-CoV-2.The second part deals with the effects of the epidemic as a stressor and the established socio-political measures on the mental health of people with and without previous mental illnesses. The literature currently available shows high symptom values for anxiety and depressive disorders as well as post-traumatic stress disorders, stress, suicidality, sleep disorders etc. Risk factors seem to include female gender, younger age and fewer resources, as well as previous psychiatric or physical illnesses. Extrinsic factors such as high infection rates, large numbers of deaths, long curfews/lockdowns, low trust in the government and ineffective measures against economic and social consequences increase the burden.

SARS-CoV-2 Neuronal Invasion and Complications: Potential Mechanisms and Therapeutic Approaches

Clinical reports suggest that the coronavirus disease-19 (COVID-19) pandemic caused by severe acute respiratory syndrome (SARS)-coronavirus-2 (CoV-2) has not only taken millions of lives, but has also created a major crisis of neurologic complications that persist even after recovery from the disease. Autopsies of patients confirm the presence of the coronaviruses in the CNS, especially in the brain. The invasion and transmission of SARS-CoV-2 in the CNS is not clearly defined, but, because the endocytic pathway has become an important target for the development of therapeutic strategies for COVID-19, it is necessary to understand endocytic processes in the CNS. In addition, mitochondria and mechanistic target of rapamycin (mTOR) signaling pathways play a critical role in the antiviral immune response, and may also be critical for endocytic activity. Furthermore, dysfunctions of mitochondria and mTOR signaling pathways have been associated with some high-risk conditions such as diabetes and immunodeficiency for developing severe complications observed in COVID-19 patients. However, the role of these pathways in SARS-CoV-2 infection and spread are largely unknown. In this review, we discuss the potential mechanisms of SARS-CoV-2 entry into the CNS and how mitochondria and mTOR pathways might regulate endocytic vesicle-mitochondria interactions and dynamics during SARS-CoV-2 infection. The mechanisms that plausibly account for severe neurologic complications with COVID-19 and potential treatments with Food and Drug Administration-approved drugs targeting mitochondria and the mTOR pathways are also addressed.

Down's syndrome and COVID-19: risk or protection factor against infection? A molecular and genetic approach

Down syndrome (DS) is the most common genetic cause of learning difficulties and intellectual disabilities. DS patients often present with several congenital defects and chronic diseases, including immunity disorders. Elevated levels of pro-inflammatory cytokines such as interleukin (IL)-6 and tumor necrosis factor alpha (TNF-α) have been seen, which appear to vary with age. At birth, patients present with combined immunodeficiency, with frequent infections that decrease with age. Furthermore, high levels of IL-4 and IL-10 with anti-inflammatory properties and low levels of IL-6 and TNF-α are described in children. The immune system is believed to play an essential role in SARS-CoV-2 pathogenesis, and it has been associated with elevated levels of pro-inflammatory cytokines and an exaggerated cytokine release syndrome (CRS) that may eventually trigger a severe situation called cytokine storm. On the other hand, genetic features seem to be involved in the predisposition to illness and its severity. Overexpression of DSCR1 and ZAKI-4 inhibits the translocation of activated T lymphocyte nuclear factor (NF-AT) to the nucleus, a main step in the inflammatory responsiveness. We discuss here the possible role of immunology and genetic features of DS in the infection and prognosis in COVID-19.