Neuropsychiatric disorders and COVID-19
Authors: Ella Burchill, Jonathan P Rogers, Dale Needham, Anthony E Lang, Timothy R Nicholson
Journal: The Lancet Psychiatry (2021)

We read with interest the Article by Maxime Taquet and colleagues1Taquet M Geddes JR Husain M Luciano S Harrison PJ 6-month neurological and psychiatric outcomes in 236 379 survivors of COVID-19 : a retrospective cohort study using electronic health records.Lancet Psychiatry. 2021; 8: 416-427Summary Full Text Full Text PDF PubMed Scopus (1139) Google Scholar in The Lancet Psychiatry that evaluated a large population (n=236 379) for neurological and psychiatric complications of COVID-19 via analysis of diagnostic codes associated with electronic health notes.1Taquet M Geddes JR Husain M Luciano S Harrison PJ 6-month neurological and psychiatric outcomes in 236 379 survivors of COVID-19 : a retrospective cohort study using electronic health records.Lancet Psychiatry. 2021; 8: 416-427Summary Full Text Full Text PDF PubMed Scopus (1139) Google Scholar The highest hazard ratios (HRs) reported were for myoneural junction or muscle disease (ICD-10 codes G70–73), with HR 5·28 (95% CI 3·71–7·53) after COVID-19 versus after influenza and 4·52 (3·65–5·59) after COVID-19 versus after other respiratory tract infection. These striking findings received little discussion in the manuscript. The incidences of specific disorders within this category were not reported and presumably were not available. Some of our author group are involved in a project providing weekly syntheses of the neurological and psychiatric sequelae of COVID-19.2Butler M Watson C Rooney A et al.The neurology and neuropsychiatry of COVID-19. JNNP Blog.https://blogs.bmj.com/jnnp/2020/05/01/the-neurology-and-neuropsychiatry-of-covid-19/Date: 2020Date accessed: April 11, 2021Google Scholar We have not yet found any large-scale publication reporting empirical analysis of specific neuromuscular disease in COVID-19. Hence, we were interested to read these new findings. We speculate that critical illness neuromyopathy might partially account for the findings. Critical illness polyneuropathy and critical illness myopathy commonly co-occur, presenting with limb and respiratory muscle weakness, and delayed weaning from mechanical ventilation. Critical illness polyneuropathy and critical illness myopathy are complications of critical illnesses, particularly sepsis, and including severe COVID-19.3Latronico N Bolton CF Critical illness polyneuropathy and myopathy: a major cause of muscle weakness and paralysis.Lancet Neurol. 2011; 10: 931-941Summary Full Text Full Text PDF PubMed Scopus (477) Google Scholar, 4Nasuelli NA Pettinaroli R Godi L et al.Critical illness neuro-myopathy (CINM) and focal amyotrophy in intensive care unit (ICU) patients with SARS-CoV-2: a case series.Neurol Sci. 2021; 42: 1119-1121Crossref PubMed Scopus (17) Google Scholar These complications are likely to adversely affect both short-term and long-term patient outcomes, and are of particular concern given the very high numbers of critically ill patients with COVID-19.5Vanhorebeek I Latronico N Van den Berghe G ICU-acquired weakness.Intensive Care Med. 2020; 46: 637-653Crossref PubMed Scopus (280) Google Scholar Within the ICD-10 system, critical illness myopathy is likely to be coded as other specified myopathy (G72.8), although there could be other possibilities within the myoneural junction or muscle disease coding (G70–73). Other diagnoses, such as myasthenia gravis, muscular dystrophy, and congenital myopathy, are generally less common. The higher risk of myoneural junction or muscle disease for patients with COVID-19 who are hospitalised versus those who are not (HR 7·76 [95% CI 5·15–11·69]) and those who are admitted to the intensive therapy unit versus those who are not (11·53 [6·38–20·83]) are compatible with critical illness polyneuropathy and critical illness myopathy potentially being an important component of this ICD-10 category. At face value, this specific finding reported by Taquet and colleagues could indicate an important neuromuscular complication in COVID-19. We recommend that COVID-19-related neuromuscular complications are investigated in more detail. Neuromuscular disorders after COVID-19 might have substantial implications for patient recovery and utilisation of physical rehabilitation health-care resources. In our view, critical illness myopathy might be the most likely explanation for this previously unrecognised, important finding. JR reports honoraria from Alberta Psychiatric Association and has attended an advisory meeting with Promentis Pharmaceuticals, outside of the submitted work. DN is principal investigator on an NIH-funded randomised trial evaluating nutrition and exercise in acute respiratory failure and, related to this trial, is currently in receipt of donated amino acid product from Baxter Healthcare Corporation and an equipment loan from Reck Medical Devices, outside of the submitted work. All other authors declare no competing interests. 6-month neurological and psychiatric outcomes in 236 379 survivors of COVID-19: a retrospective cohort study using electronic health recordsOur study provides evidence for substantial neurological and psychiatric morbidity in the 6 months after COVID-19 infection. Risks were greatest in, but not limited to, patients who had severe COVID-19. This information could help in service planning and identification of research priorities. Complementary study designs, including prospective cohorts, are needed to corroborate and explain these findings. Full-Text PDF Open AccessNeuropsychiatric disorders and COVID-19Maxime Taquet and colleagues reported an increased incidence of neurological and psychiatric disorders in patients diagnosed with COVID-19 (ie, group 1) compared with two matched control cohorts: patients diagnosed with influenza (ie, group 2) and patients diagnosed with any respiratory tract infection, including influenza (ie, group 3).1 In my opinion, having two control groups containing patients with influenza is a shortcoming of the study, and patients with influenza in group 3 should have been transferred to group 2. Full-Text PDF Neuropsychiatric disorders and COVID-19 – Authors' replyWe thank Elizabeth Charlton and colleagues, Josef Finsterer, and Ella Burchill and colleagues for their comments on our Article in The Lancet Psychiatry.1 Full-Text PDF Neuropsychiatric disorders and COVID-19We read with interest the Article by Maxime Taquet and colleagues that reports on the incidence rates of anxiety disorders after a COVID-19 diagnosis,1 and we noted from the appendix that this outcome includes codes F40–F48 of the ICD-10. Given the known occurrence of developing post-traumatic stress disorder after admission to an intensive therapy unit,2 we wondered if the authors had considered re-analysing their data to assess the incidence of post-traumatic stress disorder in survivors of COVID-19, including both those treated in intensive therapy units and those treated elsewhere? Full-Text PDF