3 Teens with COVID-19 Developed Sudden Severe Psychiatric Symptoms. Why? UCSF-Led Study Shows Unruly Immune System May Trigger ‘Turncoat’ Antibodies.
Suicidal thoughts, “paranoia-like fears,” delusions and “foggy brain” have been identified in three adolescents who had mild or asymptomatic COVID-19. Now, a new study into their immune responses identifies a potential mechanism by which these symptoms emerged.
The study, led by researchers at the UCSF Weill Institute for Neurosciences and the UCSF Department of Pediatrics, is the first to look at anti-neural antibodies – “turncoat” antibodies that may attack brain tissue – in pediatric patients who had been infected with SARS-CoV-2.
https://www.ucsf.edu/news/2021/10/421666/3-teens-covid-19-developed-sudden-severe-psychiatric-symptoms-why
https://www.forbes.com/sites/victoriaforster/2020/07/08/brain-damage-and-hallucinations-associated-with-even-mild-covid-19-coronavirus-infection/?sh=6998b81e6d91
https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2778090
Even mild COVID-19 may have long-term brain impacts.
Research presented at the Alzheimer’s Association International Conference suggests even mild cases of COVID-19 may be associated with cognitive deficits months after recovery.
One Argentinian study of 234 seniors who previously had COVID-19 found that more than half showed some degree of cognitive impairment months later. One in three had severe “dementia-like” impairments in memory, attention and executive function — a much higher proportion than the 5%–8% of seniors in the general population who have dementia at a given time.
“This could be the start of a dementia-related epidemic fueled by this latest coronavirus,” stated presenting author Dr. Gabriel de Erausquin of the Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases at UT Health San Antonio. Researchers will follow the study participants over the next three to five years to see if these problems resolve or worsen.
https://www.cmaj.ca/content/193/34/E1360
https://www.scientificamerican.com/article/even-mild-cases-of-covid-may-leave-a-mark-on-the-brain/
Warning of serious brain disorders in people with mild coronavirus symptoms
UK neurologists publish details of mildly affected or recovering Covid-19 patients with serious or potentially fatal brain conditions
https://www.theguardian.com/world/2020/jul/08/warning-of-serious-brain-disorders-in-people-with-mild-covid-symptoms
'The most terrifying thing': Some Covid-19 patients are suffering severe psychosis.
Around the world, providers are reporting a small but increasing number of cases in which Covid-19 patients with no previous history of mental health issues develop severe psychosis weeks or months after recovering from the virus, Pam Belluck writes for the New York Times.
As Belluck explains, while the virus that causes Covid-19 was initially considered primarily a respiratory disease, more and more patients are reporting a host of other symptoms, including neurological, cognitive, and psychological effects. And among these cases is a small but growing number of patients who are experiencing severe "post-Covid psychosis," providers say.
For example, a patient named Ivan Agerton—a 49-year-old documentary photographer living in Seattle, who had no personal or family history of mental illness—began experiencing crippling paranoia and auditory hallucinations weeks after recovering from a mild case of Covid-19. He believed that his neighbors were spying on his family and that police were tracking his movements.
"Like a light switch—it happened this fast—this intense paranoia hit me," Agerton said. "It was really single-handedly the most terrifying thing I've ever experienced in my life."
In another case, Hisam Goueli, a psychiatrist, helped treat a physical therapist in her early 40s who sought help at South Oaks Hospital in New York after she started to hear a voice telling her to kill herself and harm her children. The woman, who had never experienced psychiatric symptoms before, said the symptoms started just months after recovering from a mild case of Covid-19.
Goueli said he was initially unsure whether her case was Covid-related. "But then," he said, "we saw a second case, a third case and a fourth case, and we're like, 'There's something happening.'"
Indeed, while the overall number of these cases remains low—and experts expect the cases to remain rare—the reports aren't merely anecdotal, Belluck reports. A British study of neurological and psychiatric symptoms among 153 Covid-19 patients found that 10 study participants presented with "new-onset psychosis." Similarly, another study identified 10 such patients at a hospital in Spain.
Much about the condition remains a mystery, experts say
While experts don't think this trend is unique to Covid-19—psychotic episodes have sporadically occurred amid other viruses, including the 1918 flu and the SARS and MERS coronaviruses—they note that much about post-Covid psychosis remains a mystery, Belluck writes.
https://www.advisory.com/en/daily-briefing/2021/03/26/covid-psychosis
COVID Can Cause Forgetfulness, Psychosis, Mania or a Stutter
The virus induces neurological symptoms that persist long after the pandemic ends.
https://www.scientificamerican.com/article/covid-can-cause-forgetfulness-psychosis-mania-or-a-stutter/
https://www.nytimes.com/2020/12/28/health/covid-psychosis-mental.html
**COVID and the brain: researchers zero in on how damage occurs.**
Growing evidence suggests that the coronavirus causes ‘brain fog’ and other neurological symptoms through multiple mechanisms.
How COVID-19 damages the brain is becoming clearer. New evidence suggests that the coronavirus’s assault on the brain could be multipronged: it might attack certain brain cells directly, reduce blood flow to brain tissue or trigger production of immune molecules that can harm brain cells.
Infection with the coronavirus SARS-CoV-2 can cause memory loss, strokes and other effects on the brain. The question, says Serena Spudich, a neurologist at Yale University in New Haven, Connecticut, is: “Can we intervene early to address these abnormalities so that people don’t have long-term problems?”
With so many people affected — neurological symptoms appeared in 80% of the people hospitalized with COVID-19 who were surveyed in one study1 — researchers hope that the growing evidence base will point the way to better treatments.
Breaking into the brain
SARS-CoV-2 can have severe effects: a preprint posted last month2 compared images of people’s brains from before and after they had COVID-19, and found loss of grey matter in several areas of the cerebral cortex. (Preprints are published without peer review.)
Early in the pandemic, researchers speculated that the virus might cause damage by somehow entering the brain and infecting neurons, the cells responsible for transmitting and processing information. But studies have since indicated3 that the virus has difficulty getting past the brain’s defence system — the blood–brain barrier — and that it doesn’t necessarily attack neurons in any significant way.
MORE HERE: https://www.nature.com/articles/d41586-021-01693-6
https://www.who.int/news/item/05-10-2020-covid-19-disrupting-mental-health-services-in-most-countries-who-survey
January 27, 2021: Association of Psychiatric Disorders With Mortality Among Patients With COVID-19.
https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2775179
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8166317/
**SARS-CoV-2 Matter Found in Autopsied Brain Tissue**
— But neuropathological changes are likely immune-mediated, findings suggest - by Judy George, Senior Staff Writer, MedPage Today October 7, 2020.
SARS-CoV-2 -- viral RNA, viral protein, or both -- was detected in brain tissue of more than 50% of patients who died with COVID-19, a post-mortem case series in Germany showed.
However, the presence of SARS-CoV-2 was not associated with the severity of pathological changes in the brain, reported Markus Glatzel, MD, of University Medical Center Hamburg-Eppendorf, and co-authors in Lancet Neurology.
"In this case series, we show that the virus gains access to the brainstem, and we were able to pinpoint the presence of viral proteins to structures such as cranial nerves in some patients," Glatzel said.
"We did not see more severe neuropathological changes in patients with high viral loads when compared to those with no presence of virus, yet the immune reaction to the virus in the brain -- which we start to define in this study -- is there," Glatzel told MedPage Today. "This makes us think that the neuroimmune reaction may be a key factor explaining some of the neurological symptoms seen in COVID-19 patients."
This is the most comprehensive report of neuropathological findings in patients who died from COVID-19, the researchers noted.
"The emerging evidence, including the current study, shows that neuropathological alterations in the brains of patients who die from COVID-19 are relatively mild, although the virus is able to gain access to the brain," they wrote. "The neuropathological alterations are most likely to be immune-mediated, and there does not seem to be fulminant virus-induced encephalitis nor direct evidence for SARS-CoV-2-caused central nervous system damage."
https://www.medpagetoday.com/infectiousdisease/covid19/89009
More Proof COVID Severely Affects the Brain
The most comprehensive molecular study to date of brain tissue from people who died of COVID-19 provides clear evidence that SARS-CoV-2 causes profound molecular changes in the brain, despite no molecular trace of the virus in brain tissue.
"The signature the virus leaves in the brain speaks of strong inflammation and disrupted brain circuits and resembles signatures the field has observed in Alzheimer's or other neurodegenerative diseases," senior author Tony Wyss-Coray, PhD, professor of neurology and neurological sciences, Stanford University School of Medicine, Stanford, California, told Medscape Medical News.
The study was published online June 21 in Nature.
Signs of Distress
"We know that up to a third of SARS-CoV-2-infected people show brain symptoms including brain fog, memory problems, and fatigue, and a growing number of people have such symptoms long after they seemingly recovered from virus infection," said Wyss-Coray.
"However, we have very little understanding of how the virus causes these symptoms and what its effects are on the brain at a molecular level," he added.
Using single-cell RNA sequencing, the researchers studied brain tissue samples from eight patients who died of COVID-19 and 14 controls who died of other causes.
While there was no molecular evidence of SARS-CoV-2 in brain tissue samples from the patients who died of COVID-19, "we were very surprised to learn that no matter which type of cell we studied (different types of nerve cells, immune cells, or different support cells in the brain) there were prominent changes" compared with brain tissue samples from controls who died of other causes, said Wyss-Coray.
The changes in the COVID-19 brains showed signatures of inflammation, abnormal nerve cell communication, and chronic neurodegeneration.
"Across cell types, COVID-19 perturbations overlap with those in chronic brain disorders and reside in genetic variants associated with cognition, schizophrenia, and depression," the researchers report.
https://www.webmd.com/lung/news/20210628/more-proof-covid-affects-brain-study
COVID-19 and the brain: What do we know so far?
What do we currently know about the effects of SARS-CoV-2 on the brain? In this feature, we round up the emerging evidence.
How does SARS-CoV-2, the virus that causes COVID-19, affect the human brain? Recent studies have given us clues, shedding light on why COVID-19 can be so severe for some people and why the symptoms can last a long time.
There is a long history of similar viruses affecting the brain, researchers have pointed out, so many expect the new coronavirus to have this effect.
For example, Dr. Gabriel A. de Erausquin, a professor of neurology at The University of Texas Health Science Center at San Antonio, notes that “Since the flu pandemic of 1917 and 1918, many of the flu-like diseases have been associated with brain disorders.”
“Those respiratory viruses included H1N1 and SARS-CoV. The SARS-CoV-2 virus, which causes COVID-19, is also known to impact the brain and nervous system,” adds the researcher. The question is — how, and to what extent?
https://www.medicalnewstoday.com/articles/how-does-sars-cov-2-affect-the-brain
Covid-19 infects neurons, damages brain tissues, study finds.
Prashasti Awasthi Mumbai | Updated on July 02, 2021.
SARS-CoV-2 can also cause dramatic alterations in the brain’s blood vessels that could potentially disrupt oxygen supply, say authors
Researchers at Yale School of Medicine have found that coronavirus can directly infect the central nervous system.
For the study, the researchers used both mouse and human brain tissue. They intended to understand some of the virus’s effects on brain cells.
https://www.thehindubusinessline.com/news/science/covid-19-infects-neurons-damages-brain-tissues-study-finds/article33564446.ece
https://www.washingtonpost.com/health/2021/06/07/covid-are-brains-affected/
A tantalizing clue to why omicron is spreading so quickly.
"The Daily Show" contributor Jordan Klepper hit the road to talk to parents in North Carolina about why they are against masks in classrooms.
https://youtu.be/Rp0melxXhho
COVID-19's new Omicron variant is airborne, adding challenges to limiting spread.
Yes, SARS-CoV-2 (the virus that causes COVID-19) is airborne which means it can float around indoors and lingers unless the air in the room unless well ventilated...
https://www.npr.org/sections/goatsandsoda/2021/12/15/1064597592/a-tantalizing-clue-to-why-omicron-is-spreading-so-quickly
https://calgary.ctvnews.ca/covid-19-s-new-omicron-variant-is-airborne-adding-challenges-to-limiting-spread-1.5718034
https://covid19-sciencetable.ca/wp-content/uploads/2021/12/Slide-Deck_Ask-the-SAT_20211223-2.pdf
How long does Covid survive in the air?
The study on surfaces also found that SARS-CoV-2 could survive in aerosol form for 3 hours. An aerosol is a fine mist of liquid suspended in a gas, such as air. It's unknown if the Omicron variant may be able to survive longer suspended.
https://www.nejm.org/doi/full/10.1056/nejmc2004973
As the experiment ended after 3 hours, the total amount of time that SARS-CoV-2 survives in the air could be longer. However, some factors, such as air temperature and humidity, may also play an important role.
https://pubmed.ncbi.nlm.nih.gov/32404416/
A June 2020 review notes that other coronaviruses survive for longer in colder, less humid air. This may mean SARS-CoV-2 will become a more seasonal virus in some climates. The study on surfaces also did not consider how the virus might travel through the air in everyday situations.
https://pubmed.ncbi.nlm.nih.gov/32603505/
SARS-CoV-2 spreads via respiratory droplets, which are tiny drops of liquid that enter the air when a person coughs, sneezes, or talks.
A May 2020 study found that loudly talking can emit thousands of these droplets into the air, remaining airborne for around 8–14 minutes Trusted Source in a confined space.
As speech droplets do not appear to remain airborne for very long indoors, a person’s proximity to someone with SARS-CoV-2 is an important risk factor for developing COVID-19.
https://www.medicalnewstoday.com/articles/how-long-does-coronavirus-last#in-the-air
https://www.thelancet.com/journals/lanwpc/article/PIIS2666-6065(21)00269-8/fulltext
https://www.canada.ca/content/dam/phac-aspc/documents/services/diseases/2019-novel-coronavirus-infection/guidance-documents/omicron-infection-prevention-control-health-care-settings-covid-19-suspected-confirmed/omicron-infection-prevention-control-health-care-settings-covid-19-suspected-confirmed.pdf
https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/sars-cov-2-transmission.html
2-dose protection drops below 15 per cent against Omicron, underscores need for booster
Dr. Peter Jüni, the scientific director of Ontario's COVID-19 Science Advisory Table and professor of medicine and epidemiology at the University of Toronto, says COVID-19 vaccines still provide protection 'against serious outcomes' and stressed the importance of boosters.
https://youtu.be/ghOw-aQKmyI
'Is curing patients a sustainable business ...? It's Official! Curing Patients Is Bad for Business — Milton Packer describes the end result of profit-dominated drug development.
"The potential to deliver 'one shot cures' is one of the most attractive aspects of gene therapy, genetically-engineered cell therapy and gene editing. However, such treatments offer a very different outlook with regard to recurring revenue versus chronic therapies.... While this proposition carries tremendous value for patients and society, it could represent a challenge for genome medicine developers looking for sustained cash flow."
Manitoba recommending fourth vaccine dose for immunocompromised residents...
https://winnipeg.ctvnews.ca/manitoba-recommending-fourth-vaccine-dose-for-immunocompromised-residents-1.5721835
Does omicron variant mean Utahns will need a 4th COVID-19 shot?
The rapid spread of the omicron variant worldwide is focusing new attention on whether a fourth dose of COVID-19 vaccine — in effect, a second booster shot for those already considered fully vaccinated — may be necessary.
The safety and effectiveness of a fourth shot is the subject of a new, first-of-its-kind study in Israel, ahead of much of the world in coronavirus vaccinations. There, 150 medical personnel who’d gotten a booster shot at least four months ago have received another.
The Israeli government is considering a recommendation to make the extra booster dose available to those seen as most vulnerable to the new COVID-19 variant because they’re at least 60 years old, or have weakened immune systems or work in health care.
https://www.deseret.com/utah/2021/12/28/22857012/covid-19-omicron-variant-symptoms-booster-fourth-shot-utah-surge-isreal-pfizer-fauci-biden-hospitals
Israel tests 4th Covid vaccine dose, awaits ministry green light
https://www.cnbc.com/2021/12/27/israel-tests-4th-covid-vaccine-dose-awaits-ministry-green-light.html
Covid News: Omicron Hasn’t Swayed the Least Vaccinated U.S. Counties
To minimize disruptions as virus cases surge, the C.D.C. halved the recommended isolation period for infected Americans who show no symptoms, to five days. Dr. Anthony Fauci says a vaccination requirement should “seriously be considered” for air travel.
https://www.nytimes.com/live/2021/12/27/world/cdc-quarantine-isolation-guidelines
2021: 'The most terrifying thing': Some Covid-19 patients are suffering severe psychosis
Around the world, providers are reporting a small but increasing number of cases in which Covid-19 patients with no previous history of mental health issues develop severe psychosis weeks or months after recovering from the virus, Pam Belluck writes for the New York Times.
How Covid-19 will impact behavioral health services
'There's something happening'
As Belluck explains, while the virus that causes Covid-19 was initially considered primarily a respiratory disease, more and more patients are reporting a host of other symptoms, including neurological, cognitive, and psychological effects. And among these cases is a small but growing number of patients who are experiencing severe "post-Covid psychosis," providers say.
3 innovative ways to better manage behavioral health.
For example, a patient named Ivan Agerton—a 49-year-old documentary photographer living in Seattle, who had no personal or family history of mental illness—began experiencing crippling paranoia and auditory hallucinations weeks after recovering from a mild case of Covid-19. He believed that his neighbors were spying on his family and that police were tracking his movements.
"Like a light switch—it happened this fast—this intense paranoia hit me," Agerton said. "It was really single-handedly the most terrifying thing I've ever experienced in my life."
In another case, Hisam Goueli, a psychiatrist, helped treat a physical therapist in her early 40s who sought help at South Oaks Hospital in New York after she started to hear a voice telling her to kill herself and harm her children. The woman, who had never experienced psychiatric symptoms before, said the symptoms started just months after recovering from a mild case of Covid-19.
Goueli said he was initially unsure whether her case was Covid-related. "But then," he said, "we saw a second case, a third case and a fourth case, and we're like, 'There's something happening.'"
Indeed, while the overall number of these cases remains low—and experts expect the cases to remain rare—the reports aren't merely anecdotal, Belluck reports. A British study of neurological and psychiatric symptoms among 153 Covid-19 patients found that 10 study participants presented with "new-onset psychosis." Similarly, another study identified 10 such patients at a hospital in Spain.
Much about the condition remains a mystery, experts say
While experts don't think this trend is unique to Covid-19—psychotic episodes have sporadically occurred amid other viruses, including the 1918 flu and the SARS and MERS coronaviruses—they note that much about post-Covid psychosis remains a mystery, Belluck writes.
Currently, experts hypothesize that this condition may be associated with how the immune system responds to the virus, including vascular issues or inflammation. "Some of the neurotoxins that are reactions to immune activation can go to the brain, through the blood-brain barrier, and can induce this damage," said Vilma Gabbay, a co-director of the Psychiatry Research Institute at Montefiore Einstein, who has treated two patients with post-Covid psychosis.
As Robert Yolken, a neurovirology expert at Johns Hopkins University School of Medicine, explained, the immune systems of some patients who've physically recovered from Covid-19 remain activated because of "delayed clearance of a small amount of virus."
And that continuing activation of the immune system, according to Emily Severance, an expert in schizophrenia at Johns Hopkins, is currently the leading hypothesis into other brain-related symptoms of Covid-19, such as brain fog and memory loss. It's reasonable to think that post-Covid psychosis may stem from "something similar happening in the brain," she said.
In fact, the variety of symptoms may depend on what part of the brain is affected by the ongoing immune response, Yolken said. He noted that "some people have neurological symptoms, some people psychiatric and many people have a combination."
A different expression of psychosis—and an ambiguous recovery
According to experts, the experience of psychosis among Covid-19 patients seems to differ significantly from how psychosis typically presents.
Webinar series: 'Stay Up to Date' on the latest with Covid-19
For instance, while paranoid delusions typically accompany schizophrenia during late adolescence or dementia in elder adults, post-Covid-19 psychosis so far seems to primarily affect patients in their 30s, 40s, and 50s. "It's very rare for you to develop this type of psychosis in this age range," Goueli said.
In addition, while most people experiencing psychosis generally "don't have insight into their symptoms," several patients with post-Covid psychosis were aware that something was off, according to Veronika Zantop, a psychiatrist who helped treat Agerton.
There's also little consistency in symptoms among those affected by post-Covid-19 psychosis, Belluck writes, although several patients reported experiencing only mild Covid-19. For example, some patients experiencing post-Covid-19 psychosis feel urges to hurt themselves or others, much like Goueli's patient, while others—such as Agerton—experience deep paranoia rather than any violent impulses.
Moreover, while some patients require weeks of hospitalization to identify the right medications, others improve relatively quickly. Goueli's patient, for instance, was hospitalized for four weeks before doctors found a regimen of medicine that alleviated her symptoms and enabled her to return home. She's currently "95% perfect," Goueli said.
And while some patients seem to experience just a one-off episode, others struggle with relapses. For his part, Agerton was hospitalized in a psychiatric ward twice for his psychosis. While he's now returned home and says he's improving, he's still not 100%. "There's this fear of how long is this going to happen," he said. "How long am I going to live with this?"
Ultimately, however, experts hope that studying these individual cases and larger pieces of research can shed light on what remains a challenging and difficult situation. "We don't know what the natural course of this is," Goueli said. "There are just so many unanswered questions" (Belluck, New York Times, 12/28/2020; Belluck, New York Times, 3/22).
How Covid-19 will impact behavioral health services
Highest-priority behavioral health moves amid Covid-19 crisis
strategy
The Covid-19 pandemic is rapidly increasing the need for behavioral health services. But there are significant gaps and barriers that stand in the way of people getting the help they need. Download our take to learn how health systems can prioritize addressing the immediate needs of both staff and patients, especially those with preexisting behavioral health needs or comorbid conditions.
Download Now: https://www.advisory.com/topics/covid-19/2020/05/how-covid-19-will-impact-behavioral-health-services
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