Neurological, neuropsychiatric and psychiatric symptoms during COVID-19 infection and after recovery: a systematic review of observational studies (preprint)

Background The SARS-CoV-2 virus causes a wide spectrum of disease severity. Initial manifestations include fever, dry cough, and constitutional symptoms, which may progress to respiratory disease. There may also be neurological and psychiatric manifestations, involving both the central and peripheral nervous system. Methods We performed a literature search of the databases PubMed, EMBASE, The Cochrane Library and Web of Science for observational studies reporting neurological, psychiatric, and neuropsychiatric effects of COVID-19. This was followed by a narrative synthesis to summarise the data and discuss neuropsychiatric associations, symptom severity, management, and recovery. Findings The most frequently reported neurological symptoms were ageusia, hyposmia/anosmia, dizziness, headache, and loss of consciousness. Statistically significant relationships were noted between Asian ethnicity and peripheral neuropathy (p=0.0001) and neuro-syndromic symptoms (p=0.001). ITU admission was found to have a statistically significant relationship with male sex (p=0.024). Depression and anxiety were also identified both during and after infection. The most frequent treatments used were intravenous immunoglobulins, followed by antibiotics, antivirals, and hydroxychloroquine; with mean treatment duration of 6 days. Interpretation Various neuropsychiatric symptoms have been associated with COVID-19 infection. More studies are required to further our knowledge in the management of neurological and psychiatric symptoms during and after COVID-19 infection

Psychiatry and Covid-19: Acute mental health presentations before and during the pandemic (preprint)

BackgroundWe aimed to analyse numbers and types of psychiatric presentations to inform planning for future demand on mental health services in light of the Covid-19 pandemic. MethodsWe analysed electronic data between January and April 2020 for 2,534 patients referred to acute psychiatric services. We used interrupted time series analyses to compare trends in A&E and psychiatric presentations before and after lockdown, and tested for differences in patients’ demographics, symptom severity, and use of the Mental Health Act, before and after lockdown.ResultsThere were 11% fewer psychiatric presentations the first week and 64% fewer A&E presentations the first month after lockdown initiated. A higher proportion of patients were detained under the Mental Health Act (22.2% vs 16.1%) and Mental Capacity Act (2.2 vs 1.1%)(χ2(2)=16.3, p<0.0001) and they experienced a longer duration of symptoms before seeking help from mental health services (χ 2(3)= 18.6, p<0.0001). A higher proportion of patients presented with psychotic symptoms (23.3% v 17.0%) or delirium (7.0 v 3.6%) and fewer had parasuicidal behaviour (43.8% v 52.0, χ2 (7)= 28.7, p<0.0001). A higher proportion were admitted to psychiatric inpatient units (22.2% vs 18.3%) (χ 2(6)= 42.8, p<0.0001) after lockdownConclusions UK lockdown resulted in fewer psychiatric presentations but those who presented were more likely to have severe symptoms, be detained under the Mental Health Act and admitted to hospital. Psychiatric services should ensure provision of care for these patients as well as planning for those affected by future COVID-19 waves.