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London – Most people recover from severe corona infections like SARS, MERS and probably COVID-19 without psychological consequences. A meta-analysis in Lancet Psychiatry (2020; doi: 10.1016 / S2215-0366 (20) 30203-0), however, raises concerns that the stay in an intensive care unit and mechanical ventilation could cause serious mental disorders for some COVID-19 patients.
There are currently only a few studies on the effects of infection with SARS-CoV-2 on the psyche. Jonathan Rogers from University College London and co-workers found only 12 studies (including 7 as yet peer-reviewed preprints) with 976 patients. In order to expand the database, the researchers therefore included 47 studies on SARS-CoV and 13 studies on MERS-CoV in their analysis. SARS-CoV triggered a short but violent pandemic in 2002/3. MERS-CoV continues to cause serious illnesses in some Arab countries.
SARS or MERS patients often experienced psychiatric symptoms during treatment. This included confusion (27.9%), depressive moods (32.6%), anxiety (35.7%), memory disorders (34.1%) and insomnia (41.9%). One study also diagnosed steroid-induced mania or psychosis (0.7%) in SARS patients.
After discharge, depressive moods occurred in 10.5% of SARS / MERS patients, insomnia in 12.1% and anxiety in 12.3%. 12.8% complained of increased irritability, 18.9% of memory disorders, 19.3% of fatigue. In one study, post-traumatic stress disorder was diagnosed in 30.4% of patients and sleep disorder in all patients.
In his meta-analysis, Rogers estimates the point prevalence, i.e. the frequency at a certain point in time, at 32.2% for post-traumatic stress disorder, at 14.9% for depression and at 14.8% for anxiety disorders. Only 76.9% of patients returned to work in the first 3 years.
The development after a COVID-19 disease cannot yet be assessed. However, the first studies show that intensive care patients often experience delirium (69%). 21% of patients who died later were previously diagnosed with consciousness disorders. In one study, 33% had frontal brain syndrome upon discharge.
The cause of the disorders is not known. Rogers suspects that several factors play a role. In addition to a lack of oxygen as a result of pneumonia, this could include circulatory disorders, for example as a result of an increased tendency to thrombosis. Immunological consequences of the cytokine storm, which occurs in many patients, are also conceivable. Rogers also believes that SARS-CoV-2 can infect the brain. This is documented for other corona viruses.
However, societal circumstances including social isolation and psychological responses to a new serious and potentially fatal illness, or worrying about infecting other people or being socially stigmatized by the infection, could make it difficult for patients to mentally process their illness, says Rogers. © rme / aerzteblatt.de