Long COVID and neuropsychiatric manifestations (Review)

Efstathiou,Vasiliki; Stefanou,Maria-Ioanna; Demetriou,Marina; Siafakas,Nikolaos; Makris,Michael; Tsivgoulis,Georgios; Zoumpourlis,Vassilios; Kympouropoulos,Stylianos P.; Tsoporis,James N.; Spandidos,Demetrios A.; Smyrnis,Nikolaos; Rizos,Emmanouil

doi:10.3892/etm.2022.11290

Long COVID and neuropsychiatric manifestations (Review)

Authors:
- Vasiliki Efstathiou
- Maria-Ioanna Stefanou
- Marina Demetriou
- Nikolaos Siafakas
- Michael Makris
- Georgios Tsivgoulis
- Vassilios Zoumpourlis
- Stylianos P. Kympouropoulos
- James N. Tsoporis
- Demetrios A. Spandidos
- Nikolaos Smyrnis
- Emmanouil Rizos
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Affiliations: Second Department of Psychiatry, National and Kapodistrian University of Athens, ‘Attikon’ University General Hospital, Athens 12462, Greece, Second Department of Neurology, National and Kapodistrian University of Athens, ‘Attikon’ University General Hospital, Athens 12462, Greece, Clinical Microbiology Laboratory, National and Kapodistrian University of Athens, ‘Attikon’ University General Hospital, Athens 12462, Greece, Allergy Unit, Second Department of Dermatology and Venereology, Medical School, National and Kapodistrian University of Athens, ‘Attikon’ University General Hospital, Athens 12462, Greece, Biomedical Applications Unit, Institute of Chemical Biology, National Hellenic Research Foundation (NHRF), Athens 11635, Greece, Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON M5B 1W8, Canada, Laboratory of Clinical Virology, Medical School, University of Crete, Heraklion 71003, Greece
Published online on: April 1, 2022 https://doi.org/10.3892/etm.2022.11290
Article Number: 363
Copyright: © Efstathiou et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

There is accumulating evidence in the literature indicating that a number of patients with coronavirus disease 2019 (COVID‑19) may experience a range of neuropsychiatric symptoms, persisting or even presenting following the resolution of acute COVID‑19. Among the neuropsychiatric manifestations more frequently associated with ‘long COVID’ are depression, anxiety, post‑traumatic stress disorder, sleep disturbances, fatigue and cognitive deficits, that can potentially be debilitating and negatively affect patients' wellbeing, albeit in the majority of cases symptoms tend to improve over time. Despite variations in results obtained from studies using different methodological approaches to define ‘long COVID’ syndrome, the most widely accepted factors associated with a higher risk of developing neuropsychiatric manifestations include the severity of foregoing COVID‑19, the female sex, the presence of comorbidities, a history of mental health disease and an elevation in the levels of inflammatory markers, albeit further research is required to establish causal associations. To date, the pathophysiological mechanisms implicated in neuropsychiatric manifestations of ‘long COVID’ remain only partially elucidated, while the role of the indirect effects of the COVID‑19 pandemic, such as social isolation and uncertainty concerning social, financial and health recovery post‑COVID, have also been highlighted. Given the alarming effects of ‘long‑COVID’, interdisciplinary cooperation for the early identification of patients who are at a high risk of persistent neuropsychiatric presentations, beyond COVID‑19 recovery, is crucial to ensure that appropriate integrated physical and mental health support is provided, with the aim of mitigating the risks of long‑term disability at a societal and individual level.

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