Wednesday, March 27

The risk of suffering from neurological and psychiatric diseases increases two years after Covid


Updated

Results of a study on 1.25 million patient health records published in ‘The Lancet Psychiatry’ on data 14 diagnoses

The Madrid College of Psychologists launched a psychological assistance telephone line to serve professionals, relatives of the deceased and citizens at the beginning of the pandemic.ALBERTO DI LOLLI

The risk of some neurological and psychiatric conditions (such as dementia, psychosis and seizures) remains higher two years after Covid-19 compared with other respiratory infections, an observational study of more than 1.25 million patient health records published in the magazine The Lancet Psychiatry. The increased risk of depression and anxiety in adults lasts less than two months before returning to rates comparable to other respiratory infections.

Since the start of the pandemic, there has been increasing evidence that survivors may be at increased risk of neurological and psychiatric problems.. An earlier observational study by the same research group reported that Covid-19 survivors are at increased risk of various neurological and mental conditions in the first six months after infection. Nevertheless, Until now, there have been no large-scale data examining the risks of these diagnoses over a longer period of time. This study is also the first on a large scale to examine the risk of suffering from this type of condition after Covid infection in children and to assess how the risks change with the appearance of new variants.

Professor Paul Harrison, lead author of the study, from the University of Oxford, UK, said: “In addition to confirming previous findings that Covid may increase the risk of some neurological and psychiatric conditions in the first six months after the infection, this study suggests that some of these increased risks may last for at least two years. The results have important implications for patients and health services, as they suggest that new cases of neurological conditions related to Covid-19 infection are likely to occur for a considerable time after the pandemic has subsided. Our work also highlights the need for more research to understand why this is happening post-Covid, and what can be done to prevent or treat these conditions.”

sample and analysis

The study analyzed data on 14 neurological and psychiatric diagnoses collected electronic health records mostly from the US over a two-year period. Of people with health records in the US-based TriNetX network, 1,284,437 had a confirmed SARS-CoV-2 infection as of January 20, 2020 and were included in the study: 185,748 children (under 18 years of age), 856,588 adults between 18 and 64 years of age, and 242,101 adults over 65 years of age. These individuals were matched with an equal number of patients with another respiratory infection to act as a control group.

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Records of Covid patients infected during different pandemic waves were also compared to investigate differences in the impact of alpha, delta and micron variants. in the risk of neurological and psychiatric diagnoses. People who had a first diagnosis of Covid within the period in which a particular variant was dominant (alpha: 47,675 people, delta: 44,835 people, micron: 39,845 people) were compared with a control group of the same number of individuals who had a first diagnosis of Covid in the period just before the appearance of this variant.

depression and anxiety

The study found that, in adults, the risk of having a diagnosis of depression or anxiety initially increased after SARS-CoV-2 infection, but returned to the same as with other respiratory infections after a relatively short time (depression at 43 days, anxiety at 58 days). After the initial increase, the risks of being diagnosed with depression or anxiety fell below those of the control group, which means that, at two years, there was no difference in the overall incidence of depression and anxiety between the Covid-19 group and the other respiratory infections group (In adults aged 18 to 64 in both groups, in the two years after infection, there were about 1,100 cases of depression per 10,000 people and about 1,800 cases of anxiety per 10,000 people.)

However, the risk of diagnosis of some other neurological and mental health conditions was still higher after Covid than for other respiratory infections at the end of two years of follow-up. Adults aged 18 to 64 who had suffered from Covid up to two years earlier had a higher risk of cognitive deficit, or brain fog (640 cases per 10,000 people), and muscle disease (44 cases per 10,000), compared with those with other respiratory infections up to two years earlier (550 cases per 10,000 “brain fog” and 32 cases per 10,000 muscle disease). In adults aged 65 and over who had had Covid up to two years earlier, there was a higher incidence of brain fog(1,540 cases per 10,000 people), dementia (450 cases per 10,000 people), and psychotic disorder (85 cases per 10,000 people) compared with those who had previously suffered from another respiratory infection (1,230 cases per 10,000 people). brain fog330 cases per 10,000 of dementia and 60 cases per 10,000 of psychotic disorder).

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The probability of most neurological and psychiatric diagnoses after Covid was lower in children than in adultsand had no higher risk of anxiety or depression than children who had other respiratory infections. However, like adults, children were more likely to be diagnosed with some conditions, including seizures. (260 cases per 10,000 children for the Covid-19 group; 130 cases per 10,000 for the control group) and psychotic disorders (18 cases per 10,000 children for the Covid group; 6 cases per 10,000 for the control group ), for two years after infection.

With the new variants

Little change was seen in the risks of neurological and psychiatric diagnoses six months after Covid, just before and after the appearance of the alpha variant.. However, the appearance of the variant delta was associated with significantly higher risks at six months of anxiety (10% increased risk), insomnia (19% increased risk), cognitive deficits (38% increased risk), epilepsy or seizures (26% increased risk), and ischemic stroke (27% increased risk). risk), but a lower risk of dementia (40% risk decrease) compared to those diagnosed with Covid just before the delta wave. The risks during micron were similar to those when the delta variant was dominant.

“Our findings shed new light on the long-term consequences for people’s brain and mental health following Covid-19 infection. It is good news that the increased risk of post-infection depression and anxiety diagnoses is relatively short-lived.” and that there is no increased risk of these diagnoses in children. It is worrying that some other conditions, such as dementia and seizures, continue to be diagnosed more frequently after Covid infection, even two years later.“, says Dr. Max Taquet, of the University of Oxford, who led the analyses. “The appearance of the delta variant was associated with an increased risk of several conditions; nevertheless, it is important to note that the overall risk of these conditions remains low. With micron as the dominant variant, although we see much milder symptoms directly after infection, similar rates of neurological and psychiatric diagnoses are seen as with delta, suggesting that the burden on the health system may continue even with variants that are less severe in other respects“.

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More resources and support for health workers

The researchers ask that the results of their study serve as a basis for health clinics and public health policies. This study suggests that an increase in the number of new Covid cases is likely to lead to a relatively short-lived increase in the number of mood and anxiety disorders, meaning that mental health professionals must be prepared and well resourced after a wave of Covid-19. In addition, the sustained increase in the risk of some neurological and psychiatric diagnoses over the two years following Covid indicates that patients and physicians must remain alert to the possibility of these delayed conditions. Health facilities must be well supported to diagnose and treat these neurological and mental conditions, as new cases are likely to occur for a considerable time after the pandemic has subsided.

The authors warn that some important limitations must be taken into account, such as that the study may underestimate self-diagnosed and asymptomatic cases of Covid, since they are unlikely to be included in electronic health records. In addition, they did not analyze the severity or duration of each condition after diagnosis or whether they are similar after Covid than after other respiratory infections.

Dr Jonathan Rogers and Professor Glyn Lewis of University College London (who were not involved in the study) note: “As we emerge from the acute phase of the pandemic, it is critical to understand whether the resulting disability risks are transient or persistent.. The answer offered by this research – at least during a two-year follow-up period – is that it depends on the neurological or psychiatric outcome that interests us. This study is the first to attempt to examine some of the heterogeneity of persistent neurological and psychiatric aspects of Covid in a large data set. It highlights some clinical features that especially deserve further investigation, but should be complemented by prospective studies that provide further validation of the results.”

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