Psychiatric and neuropsychiatric syndromes and COVID-19 – Authors' reply
Authors: Jonathan P Rogers, Edward Chesney, Dominic Oliver, Thomas A Pollak, Philip McGuire, Paolo Fusar-Poli, Michael S Zandi, Glyn Lewis, Anthony S David
Journal: The Lancet Psychiatry (2020)

We are grateful for the letters received regarding our Article,1Rogers JP Chesney E Oliver D et al.Psychiatric and neuropsychiatric presentations associated with severe coronavirus infections: a systematic review and meta-analysis with comparison to the COVID-19 pandemic.Lancet Psychiatry. 2020; 7: 611-627Summary Full Text Full Text PDF PubMed Scopus (1586) Google Scholar which highlight the interest in this field and raise relevant clinical hypotheses. These letters illustrate a fundamental question: does infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) lead to psychiatric and neuropsychiatric morbidity merely because COVID-19 is a severe illness or because of specific factors related to this infection? There are numerous—but still comparatively rare—examples of specific neuropsychiatric presentations of COVID-19 being collated in an online blog for the Journal of Neurology, Neurosurgery & Psychiatry.2Butler M Watson C Rooney A et al.BMJ blog: the neurology and neuropsychiatry of COVID-19.https://blogs.bmj.com/jnnp/2020/05/01/the-neurology-and-neuropsychiatry-of-covid-19/Date: 2020Date accessed: July 2, 2020Google Scholar Yi-Min Wan and colleagues are correct that anosmia requires more attention, as do stroke and other neurological conditions. Current literature has not often systematically assessed anosmia,3Salazar de Pablo G Serrano JV Catalan A et al.Impact of coronavirus syndromes on physical and mental health of health care workers: systematic review and meta-analysis.J Affect Disord. 2020; (published online June 25.)DOI:10.1016/j.jad.2020.06.022Crossref PubMed Scopus (404) Google Scholar and pathological studies have been unable to elucidate whether this symptom is due to direct infection or secondary to mucosal involvement.4Solomon IH Normandin E Bhattacharyya S et al.Neuropathological features of Covid-19.N Engl J Med. 2020; (published online June 12.)DOI:10.1056/NEJMc2019373Crossref Scopus (604) Google Scholar Vijay Pattni and colleagues correctly observe that the frequency of post-traumatic stress disorder (PTSD) following admission to an intensive treatment unit is high, regardless of the illness. However, it is also probable that factors specific to the current pandemic are relevant, such as extreme social isolation, staff wearing full personal protective equipment, health-care professionals working outside their primary area of expertise, treatment with corticosteroids, and use of second-line agents for sedation. Current naturalistic studies struggle to disentangle these issues. Any recommendations should be proportionate and evidence-based. Pattni and colleagues suggest screening to identify patients at risk of developing PTSD, but we should exercise caution,5Wessely S The role of screening in the prevention of psychological disorders arising after major trauma: pros and cons.in: Ursano RJ Fullerton CS Norwood AE Terrorism and disaster: individual and community mental health interventions. Cambridge University Press, Cambridge2003: 121-145Google Scholar since outcomes could be variable and targeting individuals who have yet to develop a psychiatric disorder could have unintended consequences.6Rose S Bisson J Churchill R Wessely S Psychological debriefing for preventing post traumatic stress disorder (PTSD).Cochrane Database Syst Rev. 2002; 2CD000560PubMed Google Scholar Before implementing novel interventions, further research is required to identify an evidence base and subsequently establish clinical guidelines for minimising psychological harm after infection with SARS-CoV-2. Equally important, as suggested by Latha Velayudhan and colleagues, is implementation of existing evidence, such as appropriate management of delirium, which is likely to be seen frequently. JPR and EC contributed equally to this work. MSZ reports receiving personal fees from UCB Pharma for lecturing, outside the submitted work. PF-P reports personal fees from Lundbeck, outside the submitted work. All other authors declare no competing interests. Psychiatric and neuropsychiatric syndromes and COVID-19The systematic review and meta-analysis by Rogers and colleagues1 of acute and post-illness psychiatric and neuropsychiatric presentations of individuals with suspected or laboratory-confirmed coronavirus infection was much needed. However, it does not address one of the key susceptible groups with high rates of neuropsychiatric symptoms—people with dementia. Full-Text PDF Psychiatric and neuropsychiatric presentations associated with severe coronavirus infections: a systematic review and meta-analysis with comparison to the COVID-19 pandemicIf infection with SARS-CoV-2 follows a similar course to that with SARS-CoV or MERS-CoV, most patients should recover without experiencing mental illness. SARS-CoV-2 might cause delirium in a significant proportion of patients in the acute stage. Clinicians should be aware of the possibility of depression, anxiety, fatigue, post-traumatic stress disorder, and rarer neuropsychiatric syndromes in the longer term. Full-Text PDF Open AccessPsychiatric and neuropsychiatric syndromes and COVID-19We read with great interest the article published in The Lancet Psychiatry by Jonathan Rogers and colleagues.1 As readers with an intensive care background, we noted that the authors state in their discussion that severe acute respiratory distress syndrome (ARDS) is a key feature of COVID-19 illness. This point is contentious, with Gattinoni and colleagues2 highlighting that although severe COVID-19 might meet the ARDS Berlin criteria, it cannot simply be categorised under this syndrome alone. Clinically, often a dissociation exists between severe hypoxemia and near normal pulmonary compliance, which is not characteristic of ARDS. Full-Text PDF