Neuropsychiatric disorders and COVID-19
Authors: Elizabeth Charlton, Feroz Nainar, Sandra Reyes-Beaman
Journal: The Lancet Psychiatry (2021)

We read with interest the Article by Maxime Taquet and colleagues that reports on the incidence rates of anxiety disorders after a COVID-19 diagnosis,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 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,2Righy C Rosa RG da Silva RTA Kochhann R et al.Prevalence of post-traumatic stress disorder symptoms in adult critical care survivors: a systematic review and meta-analysis.Crit Care. 2019; 23: 213Crossref PubMed Scopus (156) Google Scholar 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? It is very concerning that 4·72% of patients with COVID-19-related encephalopathy received a first diagnosis of dementia within 6 months. We note that the authors have included F01–F03, G30, G31, and G31·83 when defining dementia, and we wondered whether the authors were able to provide more information on the incidence rates for these different types? We believe that it would be useful to know if a particular type of dementia is observed, both to help understand the pathophysiology and to help assess patients. In the appendix of the Article, the authors state that "for chronic illnesses, only first diagnoses were counted".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 In the case of dementia, were patients with a history of mild cognitive impairment (eg, F06·7) or delirium (F05) excluded? This clarification would help to establish whether COVID-19-related encephalopathy is associated with the rapid onset of dementia, or whether these patients were already a group at risk of developing dementia, considering that delirium and mild cognitive impairment can act as markers of vulnerability to dementia and can themselves lead to dementia.3Fong TG Davis D Growdon ME Albuquerque A Inouye SK The interface between delirium and dementia in elderly adults.Lancet Neurol. 2015; 14: 823-832Summary Full Text Full Text PDF PubMed Scopus (378) Google Scholar, 4Campbell NL Unverzagt F LaMantia MA Khan BA Boustani MA Risk factors for the progression of mild cognitive impairment to dementia.Clin Geriatr Med. 2013; 29: 873-893Summary Full Text Full Text PDF PubMed Scopus (138) Google Scholar We wondered if there were any data reporting on the psychiatric outcomes in patients with asymptomatic COVID-19 (given that it is suspected that these patients account for at least one-third of all COVID-19 cases5Oran DP Topol EJ The proportion of SARS-CoV-2 infections that are asymptomatic: a systematic review.Ann Intern Med. 2021; 174: 655-662Crossref PubMed Scopus (348) Google Scholar), or in patients with only mild symptoms? This information would be useful for future planning of mental health services. Finally, given that the estimated incidence of a neurological or psychiatric diagnosis in the 6 months after a COVID-19 diagnosis was 33·62%, we would propose a number of measures. First, we would suggest that questions about past COVID-19 infection become a standard part of clinical history taking. Second, we would propose that psychiatrists become an integral part of long COVID clinics nationwide. Finally, we would like to introduce the notion of reverse redeployment, in which health-care workers from general medicine might support mental health services, given the expected increased demand after this pandemic. We declare no competing interests. Neuropsychiatric 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-19We read with interest the Article by Maxime Taquet and colleagues1 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.1 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. 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 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 Access