Long COVID: Psychiatric, neurological risk still high after 2 years - Medical News Today

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Two years after the initial infection with SARS-CoV-2, people continue to face a high risk of psychiatric and neurocognitive conditions. Image credit: Emanuele Cremaschi/Getty Images.

• The SARS-CoV-2 virus and the resulting disease of COVID-19 cause varied symptoms in the short term. Researchers are still working to understand and evaluate the long-term impact of SARS-CoV-2 infections.
• Data from a new study examine neurological and psychiatric disorders that can develop in people who have experienced SARS-CoV-2 infections.
• Results of the study found that even after 2 years, people who had a SARS-CoV-2 infection were at an increased risk for several neurological and psychiatric disorders, including cognitive deficits, dementia, and seizures.

The SARS-CoV-2 virus is relatively new. There is much experts still do not understand about the long-term impact of infection with this virus.

A recent study published in The Lancet Psychiatry sought to examine some long-term psychiatric and neurological problems related to SARS-CoV-2 compared to risks from other respiratory infections.

The study found no long-term risk for some disorders such as anxiety or depression among people with COVID-19. However, the risks for other conditions, such as dementia and seizures can still be present 2 years after the initial infection.

These findings emphasize there is a need for further research into the long-term impact of COVID-19.

SARS-CoV-2 is the virus that causes COVID-19. It can cause respiratory symptoms, but people can experience a wide variety of symptoms ranging from mild to severe.

For example, people carrying the SARS-CoV-2 virus may have fever, chills, cough, congestion, or shortness of breath.

Since its emergence, SARS-CoV-2 has mutated to produce a number of variants, including some variants designated "of concern," which vary in their transmissibility and the symptoms people experience when infected.

Currently, there are many unknowns about the long-term impact of SARS-CoV-2 infections. Experts are interested in understanding how SARS-CoV-2 infections increase people's risks for other health problems.

One area of interest is how the virus impacts the risk for neurological and psychiatric problems.

Researchers used data collected as part of a 2-year retrospective cohort studies from the TriNetX electronic health records network to investigate the impact of the neurological and psychiatric impact of SARS-CoV-2 infections.

The majority of data were from the United States, but the study also included data from a number of other countries.

The researchers first identified nearly 1.2 million patients who had become infected with SARS-CoV-2 between January 20, 2020, and April 13, 2022, and pair matched them with others who had the same vaccination status, age, demographic and risk factors, who had not had COVID-19 but had experienced other respiratory infections.

Next, the authors analyzed the participants' risk for 14 psychiatric and neurological diagnoses and compared the risk for these disorders to the control cohort. They also looked at how these risks differed before and after waves of infection that were dominated by the Alpha, Delta, and Omicron variants, respectively.

While anxiety disorder symptoms increased in people when they had an active SARS-CoV-2 infection, anxiety and depression risk went down to the control group level within a few months.

The researchers also found that children were not at risk for mood disorders in the same way adults were. Children were at risk for other problems, such as cognitive deficit, insomnia, and seizures following the first 6 months after infection.

Among adults, there was an increased risk for brain fog, dementia, psychotic disorders, and epilepsy or seizures at the end of the 2-year follow-up.

The researchers further discovered that participants who had been infected with the Delta variant had an increased risk for ischaemic stroke, cognitive deficit, insomnia, anxiety disorders, and epilepsy or seizures when compared to participants who had been infected with the Alpha variant.

Finally, while the death rate decreased after the emergence of the Omicron variant, the virus still carried about the same risks for psychiatric or neurological problems compared to the Delta variant.

Study author Prof. Paul Harrison noted the mixed data results to Medical News Today:

"It is good news that the excess of depression and anxiety diagnoses after COVID-19 is short lived, and that it is not observed in children. However, it is worrying that some other disorders, such as dementia and seizures, continue to be more likely diagnosed after COVID-19, even 2 years later. It also appears that Omicron, although less severe in the acute illness, is followed by comparable rates of these diagnoses."

The study provided more extensive data about some of the long-term impacts of COVID-19. However, the study also had several limitations, including the following:

• the data mostly focused on symptomatic cases because asymptomatic cases were less likely to be recorded in electronic health records
• the researchers did not analyze the mediation of results based on the severity of illness
• only some participants contributed to the full 2-year follow-up data, indicating the need for more long-term studies
• there was a risk for people who contracted a specific variant to end up in another variant group for analysis
• vaccination status was likely under-reported in some of the data
• the researchers grouped adolescents and children together in analysis, so more research is needed regarding the long-term impacts on these age groups
• mortality incidence was likely underestimated
• it is unclear how severe each disorder was after diagnosis or if there were differences in severity based on SARS-CoV-2 infection or other respiratory infections.

Overall, the study indicates the need for more research regarding the long-term impact of COVID-19.

Dr. Arturo Casadevall, an infectious disease expert at John Hopkins University who was not involved in the study, noted the following to MNT:

"Going forward, I think we need more studies like the one described here correlating COVID-19 therapies with long-term outcomes to see if some of our interventions are more or less likely to affect the incidence of these neuropsychiatric disorders. If there is any silver lining to these catastrophic consequences of the COVID-19 pandemic is that perhaps we will learn more about the mechanistic causes for these neuropsychiatric disorders, which eventually could lead to effective prevention and treatment strategies."

Prof. Harrison noted that this data could help healthcare professionals prepare for the future.

"The findings shed new light on the longer-term mental and brain health consequences for people following COVID-19 infection," Prof. Harrison explained.

"The results have implications for patients and health services and highlight the need for more research to understand why this happens after COVID-19, and what can be done to prevent these disorders from occurring, or treat them when they do," he added.